On Tuesday, 2 April, head of the department for Gauteng Health Professor Mkhululi Lukhele appeared in order to answer allegations made during a South African Human Rights Commission (SAHRC) investigation into the provincial healthcare system.

In 2018 the commission visited five hospitals in the province — Tembisa Provincial Tertiary Hospital, Steve Biko Academic Hospital, Charlotte Maxeke Johannesburg Hospital, Thelle Mogoerane Hospital and the Rahima Moosa Mother and Child Hospital. During the visits, challenges faced by both the health practitioners and service users were presented to the commission.

The investigation was prompted by media reports of negligent patient treatment at some Gauteng hospitals, the commission said. The SAHRC had decided to conduct preliminary investigations into the provincial healthcare system.

Opening the session, provincial head of the SAHRC Buang Jones said, “the purpose of this session is to present allegations to the head of department and observations made by the commission during the visits”.

Divided into four themes — management, medical equipment and infrastructure, environmental health and oncology — the discussion began with concerns raised about the management systems for hospitals. Senior legal researcher for the commission Jackson Mzila said that management of some hospitals visited raised concerns about the existence of centralised systems of authority.

Responding to Mzila’s probe, Lukhele said:

“To be a good leader and to be able to tackle this big task, delegation is imperative. We have what we call ‘cascading delegation’. One of my mandates is to ensure that the Gauteng community has access to quality and efficient health services.”

Mzila maintained that the department had delegated multiple functions in order to avoid a centralised system.

A major concern raised by the commission was the existing shortage of clinical staff in health facilities, although, according to the department’s annual report, 1,320 health practitioners were hired, with medical doctors making up most of the placements.

Lukhele told the commission that “10 years ago this province had about seven million people and now it’s sitting at 14.4 million. Gauteng has suffered the most shrinkage of health providers. You compound that with the increase in demand, it is a system that is jamming. However, it is a national issue and has gone into the presidential health stimulus package”.

Ironically, there are qualified nurses and doctors that have not been placed into the system. In January 2019 City Press reported that 216 qualified nurses in Gauteng were still without jobs.

“We are concerned as a department that the nurses we produce, we can’t retain them,” Lukhele said.

Even though the department produces the majority of health practitioners, according to Lukhele, it struggles to absorb all of them into the workforce due to budget constraints.

Furthermore, on Mzila’s finding that some hospitals hire agency nurses, who come at a higher cost than nurses produced by the department, Lukhele said:

“In nursing, there is what we call ‘specialised nursing’. Those nurses, public or private, are scarce and most of them prefer to be in agencies because then they make more money. While we want to kill that component, it is an essential component at the moment. They are needed on a temporary basis when specialised care is needed.”

Another issue brought to the commission is environmental health in hospitals. In 2018, six infants died at Thelle Mogoerane Hospital in Vosloorus due to an outbreak of Klebsiella pneumonia. Following the deaths, the commission’s visit to the hospital revealed severe hygiene negligence.

Lukhele said there was a link between medical staff shortages and negligence. He said in cases where there was one nurse in charge of one ward, there was a chance that certain preventative procedures would be neglected.

Other themes discussed were medical equipment, infrastructure and oncology.

Medical Brief reported that the Gauteng Department of Health had irregular expenditure costs amounting to R1.7-billion, according to the Auditor-General’s 2018 report.

However, considering that Lukhele assumed the role of HOD in April 2018, the commission said he could not be held liable for the previous financial year.

The commission said it would not issue an adverse finding report.

“Instead, the commission will commence with the process of engagement with the department which will culminate in the signing of an agreement between the department and the commission. Some of the salient features of the agreement will be to have clear commitments from the department on submissions of periodic reports to the human rights commission,” Jones said.

Jones said the agreement will be used to track changes made by the department and to evaluate plans to handle the concerns raised. DM