Public Protector Busisiwe Mkhwebane, who is visiting Gauteng hospitals, has lashed out at the government for dragging its feet in preparing facilities to fight COVID-19. The Star reports Mkhwebane’s deputy, Kholeka Gcaleka, did a walkabout and met staff and management at Chris Hani Baragwanath Academic Hospital.
In May, the Gauteng Infrastructure Development Department committed its intentions of providing a total of 3,056 beds. It has only managed to provide 1,126 beds from external entities so far.
Mkhwebane warned that the dragging on of these projects might be linked to wasteful expenditure as COVID-19 restrictions decrease. “What we found at our facilities is that some of the construction is taking so long. We thought that with the lockdown, things would be ready by now. You will find that after COVID-19 some of this infrastructure would not be utilised and that is a problem because it will have an element of wasteful expenditure.”
The report says during her walkabout at Baragwanath, Gcaleka said the hospital did not have sufficient capacity to handle the pandemic. “The hospital doesn’t have enough capacity, I think the staff are doing the best they can given the circumstances but they definitely need to improve. Should there be a second surge of the pandemic, they will be challenged.”
The Charlotte Maxeke Academic Hospital has to date recorded 731 staff members who have tested positive since the start of the COVID-19 pandemic, the facility's management has told the Office of the Public Protector. News24 reports that the affected staff has been broad, ranging from support and contractors to students. Only 37 staff personnel were active cases and five were hospitalised, with four being in ICU. Eight employees succumbed to the virus – two nurses, five cleaners and one cashier. At least 679 workers have recovered.
The hospital informed Deputy Public Protector advocate Kholeka Gcaleka that among the infected staff were nurses, who made up the bulk staff complement, followed by cleaners.
The acting Gauteng Health MEC Jacob Mamabolo has committed to improving operational efficiencies to ensure that the Gauteng Health Department moves with speed to deliver on its mandate. MEC Mamabolo said this whilst presenting the Gauteng Health Department 2020/2021 Financial Year first quarter report to the Gauteng Health Portfolio Committee Virtual meeting held on Thursday, 20 August 2020.
“In the clinical services the big difficulty they have, which affect the core business of the Department is mainly the support services, if you look at infrastructure, medical devices, human resources, the maintenance of infrastructure, issues around linen and many other support items, clinical staff requires, if we were to address those we will go a long to improve operational efficiencies in the department,” said MEC Mamabolo.
The first quarter performance coincided with the COVID-19 lockdown period which impacted on the uptake of services in a number of ways. Whilst creating a balance in the provision of essential services and addressing the pandemic, the department has committed to making sure that the current global crisis due to the pandemic is not wasted by ensuring that there is acceleration of projects which will result in sustained improved service delivery platform for the benefit of the people of Gauteng.
In a bid to improve its performance, the Gauteng Health Department has implemented remedial strategies which are as follows:
Implementation of a modified model of care with a special focus on community-based provision of services/interventions – taking family planning, growth monitoring, immunizations to the community instead of facility-based provision; prioritisation of routine maternal and child health services, and facility visits are underway including strengthening of mortality surveillance; COVID-19 related assessments will be carried out to check conformity to COVID-19 rules instead of Ideal Hospital Assessment; further investigations are being carried out to determine the causes of data discrepancies and assess progress on targeted interventions being implemented; districts were encouraged to provide integrated HIV, Aids and Sexually Transmitted Infections and Tuberculosis. (HAST) services that were integrating COVID-19 at health facilities and community settings daily; HIV testing services will be monitored weekly to ensure adhering to catch-up plan that was developed. Daily target setting at health facilities and strengthen index testing daily were also done; investigations are underway to determine causes of deaths for both children due to pneumonia and diarrhoea; strengthening of mortality and morbidity surveillance across all level of care; in terms of addressing under and over expenditure, the department will revise the Section 40 projections during the November adjustment budget process.
The effect of lockdown on the overall performance of the organisation which is largely demand driven has been unsatisfactory, and this is seen in the following:
The overall target performance of the first quarter is 53% and this shows a 11% decline from Q4 of 2019/20 financial year; the volumes of patients that were seen in PHC facilities declined significantly by 26% compared to the same period in 2019/20; during Q1 2020, the highest volumes of patients were seen in National Central Hospitals at 49% followed by Regional Hospitals at 27%; the COVID-19 has impacted negatively on the implementation of prioritised projects such as the number of headcounts at hospitals and PHC facilities declined, acquisition and first implementation of Health Information Systems; priority programmes such as HAST and Maternal Child and Women’s Health (MCWH) were affected by traveling restriction of staff which resulted to low uptake of PHC services; the number of deaths due to diarrhea and pneumonia was higher than expected in the first quarter.
Expenditure Patterns and its remedial actions:
The reasons below are based on the section-40 projections v/s actual expenditure for the first quarter:
Administration: (Over-spending) – This programme is reporting projected overspending due to continued payment (s) of medico legal claims against the state and the effects of centralisation of the COVID-19 expenses within this programme.
District Health Services: There is due delays in filling of posts from funds set aside as a contribution towards COVID-19 Human Resource capacity from reprioritisation.
Emergency Medical Services: The delays in the creation and filling of posts also adversely affected this programme while e-Gov. worked on expediting outstanding mandates;
Provincial Hospital Services: The effects of delays indicated in the previous programmes also adversely affected the financial performance of this programme as it relates to funds that were set aside through reprioritisation as a contribution towards COVID-19 Human Resource.
Central Hospital Services: The reported less than anticipated spending arose as a result of the non-implementation of the cost of living adjustments that were anticipated with effect from the beginning of the financial year.
Health Sciences and Training: There were delays in filling posts dedicated for the new Gauteng College of Nursing structure as a result of the effects of lockdown for the period under review which affected the performance of the programme.
Health Care Support Services: There was a reported increase in costs due to the effect current gas contracts and the increased demand for laundry services and food service during lock down.
Health Facilities Management: There was increased spending within this programme as the service delivery platform was being prepared to effectively respond to the effects of COVID -19. Generally, less patients were presenting at various facilities for the period under review which affected the spending patterns.
Despite all the challenges the Department noted an improvement in the percentage of Primary Health Care facilities with average waiting times below 100 minutes and antiretroviral therapy (ART) adults who remained in care increasing by 2% in the first quarter. There was an improvement in maternal and child health programme in the following measurements, antenatal care (ANC) for first visit before 20 weeks and severe acute malnutrition (SAM) retaining performance below the threshold of 7% and declined by 84%.
Issued by Gauteng Health Department
The Public Protector is, meanwhile, investigating a possible breach of the executive ethics code by KZN Health MEC Nomagugu Simelane-Zulu, after a complaint was laid by the DA regarding COVID-19 statistics. A Polity report says the Public Protector’s spokesperson, Oupa Segalwe, confirmed the investigation.
“The Public Protector is looking into the complaint that the MEC breached the Executive Code of Ethics by allegedly refusing to release COVID-19 statistics to the public.”
The DA's KZN Health spokesperson, Dr Rishigen Viranna, said the party applauded the decision.
The report notes Simelane-Zulu has come under fire for not releasing local information related to the virus, which could help inspire behavioural changes and stem an increase in infections.
Viranna said the DA had filed a request with Simelane-Zulu’s office at the beginning of the lockdown in March for daily COVID-19 information from local municipalities and sub-districts, but did not receive it. “We’ve been asking for the localised information and the hot spot information since March, since the beginning of the beginning of the lockdown,” Viranna said.
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[link url="https://www.polity.org.za/article/public-protector-investigating-kzn-health-mec-over-potential-ethics-breach-2020-08-19"]Full Polity report[/link]