A senior government officials says budget constraints have led to delays in paying service providers to maintain health facilities in Gauteng.
Bawinile Malope, from them provincial Department of Infrastructure Development, responsible for carrying out the maintenance at health facilities in the province, was giving a presentation on Monday at the Human Rights Commission (HRC).
The commission is engaging with the Departments of Health, and Infrastructure Development, and Treasury as part of its monitoring of the healthcare system.
Malope said maintenance requirements in health facilities exceeded the budget and they were operating on a shortfall of R1.2bn to deal with infrastructure issues.
“In some hospitals, we have service providers who refuse to render their services because they have not been paid. Some payments are outstanding from as far back as September,” Malope told the commission.
She said most of their service providers were for specialist services, such as the maintenance of lifts and generators.
Referring to earlier this year when lifts were not working and could not be fixed, she said: “At some hospitals, we had our service provider completely pull out because of non-payment.”
Malope said load shedding was adding to the strain of hospitals and clinics, and only the Steve Biko and George Mukhari hospitals were exempt from Eskom’s enforced power cuts.
“Since the end of May, generators at hospitals have been battling to keep up with the constant cuts. We have been seeing a lot of equipment failures,” she said.
Recently (1 June 2022), MedicalBrief carried an article which had featured in Spotlight: it said that two years after the Public Protector (PP) found that the Health Department had failed to ensure appropriate conditions for the delivery of healthcare services, the situation at some of these hospitals had deteriorated even further.
After visiting several hospitals in Gauteng in 2020, the PP had made several recommendations, which the provincial health department said it had implemented.
However, when Spotlight asked PP spokesperson Oupa Segalwe about the progress in implementing the recommendations, he said no response had been received other than acknowledgements of receipt from the responsible authorities.
Highlighted in the PP’s reports were occupational health and safety hazards, especially regarding infrastructure and maintenance.
A case in point was the fire-ravaged and dilapidated Charlotte Maxeke Academic Hospital, the repairs of which are nowhere near being completed: the damage and the delays been linked with arson, sabotage and corruption.
“We are running around like headless chickens. Nothing is getting fixed properly and the only successes have been when Solidarity or Gift of the Givers have come in and taken over,” said a doctor who has worked at the hospital since 1997. “The government should be embarrassed that an NGO had to come and dig a borehole to supply a public hospital with water,” he added. “The place is falling apart around us.”
Russell Rensburg, director of the Rural Health Advocacy Project (RHAP), said throwing money at the problems is not enough.
The challenges could only be solved with a proper evaluation of what the health system does with the money (allocated to them) and looking at where there are inefficiencies, he said, adding that Gauteng receives enormous budgets compared with other provinces.
As far back as September 2019, then Wits vice-chancellor Adam Habib challenged Gauteng Premier David Makhura’s call for the national Health Department to finance the province’s debt-ridden teaching hospitals, saying centralising their funding without fixing their deep-seated administrative and governance challenges would not give patients a better deal.
Habib told Business Day: “The whole system needs to be fixed.”
He was responding to a statement issued by Makhura in which he called on the Health Department to finance the four facilities – Charlotte Makexe, Steve Biko, Chris Hani Baragwanath and Dr George Mukhari hospitals – directly, saying that they were under-funded for their role and collectively, at that stage, owed R1.4bn to suppliers.
The central hospitals receive ring-fenced conditional grants that are overseen by the national health department, as well as an allocation from the provincial health budget.
Habib suggested that central hospitals should be overseen by an independent board, which would appoint the CEO, and the facilities should employ clinicians directly. Hospital CEOs are appointed by the provincial health department.
The engagement with the SA Human Rights Commission continues.
See more from MedicalBrief archives:
Sabotage and apathy behind Gauteng Health’s failure to repair Charlotte Maxeke – Prof Mahomed
Gauteng hospitals deteriorate further after damning PP report
Gauteng Health too broke to fight third wave