South Africa

Health-e News: Eastern Cape poverty – the State is also ‘captured’ by incompetence

By Health-e News 5 February 2018

More than 23 years after South Africa’s first democratic elections, many Eastern Cape residents still live in dire poverty – held hostage as much by incompetent officials as corrupt ones. Is there any political will to turn the country’s poorest municipalities around? KERRY CULLINAN reports for Health-e News.

Although it is famous among middle-class tourists for its exquisite beaches and potent weed, life in the OR Tambo district municipality in the former Transkei is far from beautiful for its residents.

The district is one of the most deprived places in the country. Barely 6% of homes have piped water while less than one in 10 households have flush toilets.

It is home to almost one and a half million people – two-thirds of whom are under the age of 25. Yet most young people are unemployed, only 18% of residents have finished school and a mere 6% have higher education. Close to 60% of households are headed by women, many of whom are pensioners.

OR Tambo’s northern neighbour, the Alfred Nzo municipal district, encompasses part of the Maluti mountains and the southern Drakensberg, and over 840,000 people call it home.

Living conditions in Alfred Nzo are even more dire than in OR Tambo. Here, less than 3% of households have piped water and less than 5% have flush toilets. Unsurprisingly, diarrhoea is rife among children younger than five, which is often linked to poor sanitation and lack of clean water. One tenth of the deaths of pre-school children are due to malnutrion.

The district also has the highest rate of teen pregnancies in the country, and almost 13% of births are to girls under the age of 18 – almost double the national average.

This is according to the District Health Barometer 2016/17, compiled by the Health Systems Trust and released last week. Every year for the past 12, the annual barometer has published the health profiles of the country’s 52 municipal districts – and every year, OR Tambo and Alfred Nzo are at the bottom of the pile: poor, hopeless places that no one seems to have any will to turn around.

Yet parts of both districts are in places that could be very attractive to tourists. Provincial politicians have floated the idea of a “waterfront development” at Port St Johns to revive the town, which is situated in one of the most beautiful coastal areas in the country. It’s a nice idea but the municipality was only able to spend 35% of its budget in 2017, according to a report from the provincial Treasury. This saw more than R42-million, which should have been used to improve the town, returning to the Treasury.

Why was the money not spent? Simply because the officials and politicians lack the skills and competence to manage the sub-district. While they may not have put the money into family weddings or a mansion in Dubai, it has not reached the people it was supposed to help so, for them, it has the same effect as if it had been stolen.

Incompetence and lack of capacity take on deadly dimensions in the health sector. The province is facing medico-legal claims totalling over R17-billion (the entire annual health budget is R21-billion).

The Auditor General identified that a significant number of the medico-legal claims relate to maternal care and cerebral palsy at the Mthatha General Hospital,” DA MPL Celeste Barker told the legislature in November.

Mthatha Hospital is the main referral hospital for district hospitals in both OR Tambo and Alfred Nzo. Cerebral palsy is a neurological condition that affects a person’s ability to move. Prolonged labour, during which a baby is deprived of oxygen or gets a head injury, is a common cause – and is often a symptom of sub-standard medical care.

As 95% of residents have no medical aid, it is imperative that the public health system is fixed. But health services don’t look as if they are going to get better any time soon. In fact, things might get even worse.

Last year, the provincial health budget was increased by a mere 5.7%. This was lower than the inflation rate (6.6%), which effectively means that health spending is decreasing, not increasing.

For the past five years, OR Tambo district has been a National Health Insurance (NHI) pilot district. This means that it got extra funds and support from national government to improve its health system. While certain indicators – mostly HIV-related – have improved, many of the residents’ health woes have their roots in their socio-economic conditions and unless these are addressed, their health status will not improve. For example, both districts have very high hypertension rates and growing rates of diabetes, in all likelihood linked to poor diets.

The poverty of OR Tambo and Alfred Nzo districts is directly linked to the wealth of the gold mines. The former Transkei was the country’s first “labour reserve” for the mines. From the time of Cecil John Rhodes in the 1890s, there was an onslaught against economically independent black farmers, who were driven off their land and into the mines by a combination of hut taxes, anti-squatter laws and labour taxes.

In the past decade, as the fortunes of the mines have faltered, ex-miners with tuberculosis and HIV, dying of silicosis, have been sent back to their rural homes, further draining the health services.

It is unrealistic to expect the Eastern Cape government alone to repair the structural damage of more than a century. There should be a national intervention to redress the damage and suffering in the rural Eastern Cape. – Health-e DM

File Photo: A woman walks with water near Coffee Bay, Eastern Cape, 06 May 2014, one of the poorest and most crime affected areas in the country. Photo: EPA/Kevin Sutherland



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