The TAC and Section27 collected reports on the Gauteng health system throughout 2012. “At 22:00 last night there was an oxygen failure, from the VIE supplying our main theatre, ICU and a large part of the hospital. It apparently took three hours to sort out… Fortunately we did not have any patients on the table in theatre, but I am concerned that there may be a patient morbidity in the wards because of this,” wrote a doctor at Johannesburg’s central hospital in September last year. “Then, as you know, we had a power failure at 03:00 and the generator to theaters one and two did not kick in. Caesarean sections had to be completed by cell phone light!”
Another doctor at a Johannesburg regional hospital was aghast at the challenges of vaccinating infants. “We have recently had two infants die on ventilators in our ICU with proven pertussis (whooping cough). One was not immunised, but the other had regularly been to the clinic, but the vaccine was out of stock!”
On Monday, Section27 and the TAC launched “Monitoring Our Health: An analysis of the breakdown of the healthcare services in selected Gauteng facilities”. The report reviews the province’s healthcare services during 2012 and sheds light on the key concerns, while including comments from healthcare professionals and patients.
The verdict is grim. “Healthcare in Gauteng is being severely compromised. The failure to manage finances and ensure that facilities are functioning efficiently has led to serious consequences including increased morbidity, disability, stillbirth and death,” it reads.
Premier Nomvula Mokonyane took a different tone in her state of the province address last week. She spoke proudly of the Gauteng Department of Health’s turnaround since 2009, saying the system “is well on its way to recovery and has pockets of excellence that we should celebrate and further enhance.” To back the claim, she mentioned improvements in financial management, infrastructure, distribution of medicines, increased vaccinations, a reduction in neonatal deaths and gains in the fight against HIV/Aids.
Many of those are the same issues the TAC and Section27 say are failing patients. TAC Secretary General Vuyiseka Dubula said Monday she expected the national Department of Health to place Gauteng’s system under administration in 2012 before the ANC’s Mangaung conference.
That didn’t happen, but Dubula says the civil society groups will give Health MEC Hope Papo one month to make drastic changes, or they will take the province to court for failing to meet its constitutional obligation to provide adequate health services.
According to “Monitoring Our Health” there are three causes of the crisis: improper budgeting and financial management; poor supply chain management; and poor management. Years of rampant corruption and mismanagement have gone unpunished. An investigation by the Special Investigations Unit into allegations against the provincial department between 2006 and 2010 remains sitting on President Zuma’s desk. And in 2011/12 the Auditor General found huge amounts of unauthorised, irregular and wasteful expenditure along with poor procurement practices and a failure to investigate misconduct when required.
The TAC and Section27 found the provincial department’s budget failed to reflect the changing nature of the province’s population or its health needs. While the population increases and healthcare costs rise, the department has failed to match its budget correspondingly and meanwhile continues to waste money. Combined with mismanagement, the consequences are dire, and according to the civil society organisations, constitute a breach of the constitution and Public Finance Management Act.
The report mentions a range of areas of breakdown in health services. It estimates 25% of essential medicines are unavailable due to stock shortages and distribution mismanagement. Many children are missing out on vaccinations because the medicines are not available, says the report, which is of “grave concern” – “particularly since some pediatricians have reported cases of children suffering from diseases they should have been immunised against.” HIV/Aids patients are often not being screened for TB because of shortages in testing materials and shortages in certain antiretrovirals means patients are not receiving medication or receive substitutes, increasing side effects and the chance of developing drug resistance.
“I think we’ve never seen in terms of the stock-outs what we’ve seen in 2011-12,” said Dubula, regarding the vaccines.
The report also mentions severe shortages of basic materials – from syringes to soap – while equipment is either unavailable or not maintained. One oncologist wrote, “We may not be able to offer a curative service soon and will be limited to providing only palliation for cancer patients, if essential components of treatment… do not become available soon.”
Section27 executive director Mark Heywood acknowledged that some of the information in the report had been noted before. “It’s not new, but I think that’s part of the problem. People in this province have become accustomed to deteriorating health services and extremely poor health services.” He said the groups are determined to make 2013 a turnaround year for Gauteng health. “This is the year they’re going to fix it.”
Speaking on Saturday, the Health MEC Papo was optimistic about the improvements made. He acknowledged there was a raft of problems in 2009, but said: “We owned up to these problems and developed a turn-around strategy (TAS) 2012-2014 to ensure the department moved away from organisational decline and collapse of service delivery.” Papo said essential drug stocks had improved from 40% to 70% during 2012 and he plans to get it to 98%. After help from the national government, Gauteng health has been able to improve its financial position, settling a large amount of its long-term accruals.
The civil society organisations, however, expressed concern that health services are being compromised to balance the books. The report noted a number of areas, such as staff appointments and payment of nursing agencies, which were put on hold or reduced in 2012 to save money. “The HR department tells me they have applied for more than 100 vacant posts to be filled since the beginning of the year. They had the applicants. Only five Registrar’s posts were approved,” wrote a doctor in July 2012.
Section27 and the TAC make a number of recommendations detailing how to achieve a better managed, better organised, and more accountable health department. The list of measurable goals, targets and oversight mechanisms to implement look like something one might put in front of a judge. But before that happens, they’ll be looking at the Gauteng budget that will be presented on Tuesday. DM
Photo by Greg Nicolson.
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