DM168

DM168 ANALYSIS

Mkhize’s legacy of shame: Baby deaths, doctor and nurse shortages, a collapsed Eastern Cape health system

Health Minister Zweli Mkhize during his visit in Gqeberha. (Photo: Deon Ferreira)

We asked Minister of Health Zweli Mkhize, who is now on special leave, 89 times what he is going to do about health services in the Eastern Cape. The number of times he answered: ZERO.

First published in the Daily Maverick 168 weekly newspaper.

In March 2021, Minister of Health Dr Zweli Mkhize was asked why he had not placed the Eastern Cape Department of Health under administration.

Three months later, with at least six newborn babies dead, specialist services for children with cancer collapsing and a dangerously low number of Covid-19 beds available in one metro, neither Mkhize nor his officials have given an answer.

Calls for Mkhize to resign or be fired were instead anchored in his alleged involvement with Digital Vibes, a communications company appointed by the national Department of Health that is being investigated for allegedly paying money to the Mkhize family.

None of these calls, however, mentions the human rights crisis that was already close to full-blown in March, when Mkhize last visited the Eastern Cape.

Senior health officials told him in March 2021 that the Eastern Cape Health Department would run out of money by July.

When health officials sounded the alarm, three babies were dead at Dora Nginza Provincial Hospital in Gqeberha because of hospital-acquired infections in a shockingly overcrowded neonatal unit, where one nurse sometimes had to look after 28 babies. Since then another three babies have died in preventable accidents in the ward.

One of the province’s main Covid-19 hospitals, Livingstone Hospital in Gqeberha, is only able to provide four ICU beds and does not have enough doctors or money to provide 24-hour medical care to those admitted to the Covid-19 ward.

The Paediatric Oncology Unit, which is part of Livingstone Hospital, is facing closure as dire staff shortages make it unsafe for children to be treated there.

After four years, Livingstone, one of the province’s main tertiary hospitals, still only had an acting CEO with no permanent appointment being made.

In February, Premier Oscar Mabuyane replaced MEC of Health Sindiswa Gomba with Nomakhosazana Meth.

During high-level presentations to Mkhize, the department highlighted the heavy burden of medico-legal claims on its budget and warned that it would run out of operational funds, with the exception of payroll, by July.

The department had already used about 16% of its budget before the financial year had even started in April and still owed service providers around R4-billion. The patient registration system had to be shut down because the service provider that manages it had not been paid.

Earlier this year, Meth admitted that R3.5-billion of the department’s substantial payroll was allocated to nonmedical personnel – this in an environment where the heads of clinical units were effectively barred from appointing clinical staff by the provincial cost-containment committee, which is shrouded in mystery and which has refused to make many medical appointments.

Department spokespeople have refused to identify who sits on this committee, how many appointments it has made and who has oversight over it.

Following the March presentation, DM168 asked for an in-person interview with Mkhize. The request was agreed to but then Mkhize’s spokesperson, Dr Lwazi Manzi, said that the minister “had a car waiting”.

Eventually it was agreed that he would answer questions from DM168 on the state of the Eastern Cape Department of Health in writing.

We asked these questions another 89 times – and have not yet received a single response except for an off-the-record interview with a senior health department official.

The most pressing question of all was: Why has the Eastern Cape Department of Health not been placed under administration?

The provision of health services is a provincial competency, as is the determination of the provincial health budget, with the exception of grants that are aimed at providing support and creating specialist services in provincial tertiary hospitals. But section 100 of the Constitution allows for a national intervention in a provincial administration when “a province cannot or does not fulfil an executive obligation in terms of the Constitution”. The Constitution provides that the national executive may intervene by taking any appropriate steps to ensure the fulfilment of the obligation.

What we have received in response to our questions have been many excuses: The minister is busy with the vaccines, the minister is going on hospital visits and then a more hopeful “The minister is looking at your questions.”

And a not so hopeful: “The minister wants to consult with the director-general first.”

And then nothing.

The Eastern Cape Department of Health or parts of it have been placed under administration before – more than once. Currently, its mental health programme is under administration, although Prof Dan Mkhize, the administrator who was appointed following an investigation by health ombudsman Prof Malegapuru Makgoba into mental health services in the province, died last year due to Covid-19 complications. It does not appear that a replacement has been appointed.

In 2020, following a visit to the province, Mkhize seconded Dr Sibongile Zungu from the national Department of Health to co-ordinate the province’s chaotic Covid-19 strategy. Zungu drew up a report on the state of health facilities in the province that Mabuyane’s office has refused to release, instead saying that a summary made by them was enough.

When Meth was asked if she would consider releasing the report, her answer was: “I will have to study the report and understand the issues raised but the fact that we have already invited our stakeholders to the strategic session illustrate that, we are not shy to talk about any challenges confronting us in the department.”

Zungu managed to redesign a plan for the depleted ambulance service and with NGO assistance, oxygen supply to the province’s hospitals was improved, almost exclusively for Covid-19 cases.

But at the end of August 2020, the then head of the Eastern Cape Health Department, Dr Thobile Mbengashe, resigned from his post to join the Office of the Premier as a consultant. He then appeared to take over the Covid-19 response while Zungu became the acting superintendent of the department.

Meanwhile, doctors in the public sector started sounding the alarm that hospitals were running on empty with crippling staff shortages including nurses, doctors and specialists in some fields.

The Neonatal Unit has perennially run at over 100% bed occupancy, and for the past few months [over five months] the number of newborns in the unit has been between 100 and 110 virtually daily. These babies have been admitted into a space for 70 which has obviously led to overcrowding and increased risk of infection. Indeed there have been outbreaks of infections with multi-antibiotic resistant organisms, which has led to deaths of some babies. Others may have died because they couldn’t be accommodated in the neonatal ICU and Neonatal High Care Unit.

The paediatric departments felt these shortages most acutely due to their high demand for nurses.

Livingstone Hospital in Gqeberha, housing the specialist units in Nelson Mandela Bay, has not had a permanent CEO since 2017, when Thulane Madonsela and his management team were chased out of the hospital by angry union members.

This week, Meth admitted that both the neonatal unit based at Dora Nginza Provincial Hospital and the Paediatric Oncology Unit based at Port Elizabeth Provincial Hospital were facing severe nurse shortages. Both fall under the tertiary Livingstone Hospital, even though they are not based at Livingstone Hospital.

“The Neonatal Unit has perennially run at over 100% bed occupancy, and for the past few months [over five months] the number of newborns in the unit has been between 100 and 110 virtually daily. These babies have been admitted into a space for 70 which has obviously led to overcrowding and increased risk of infection. Indeed there have been outbreaks of infections with multi-antibiotic resistant organisms, which has led to deaths of some babies. Others may have died because they couldn’t be accommodated in the neonatal ICU and Neonatal High Care Unit.

“The nursing staff complement is inadequate for the 70 beds, even worse when it has over 100% occupancy. Space is available to expand the neonatal unit by 24 beds, but their most critical need is for staffing. The department has identified the need for nurses in the neonatal units and is reprioritising funding to fill priority posts which include the neonatal ICU and High Care at Dora Nginza Hospital,” she said.

Answering a question about the severe staff shortages that have led to limited operations in the Paediatric Oncology Unit, Meth said: “The Paediatric Oncology Unit at the PE Provincial section of Livingstone Tertiary Hospital has had a severe shortage of nurses and furthermore lost a number of nurses due to deaths from Covid-19 and cancer, resignations and retirement. The dire nursing staff shortages are such that the unit will need to close down, as there are very few nurses to keep it functional even at a minimal level. In the short term, Livingstone Hospital has identified nurses that could be seconded to the Paediatric Oncology Unit. The department will prioritise posts for the current financial year to fill the critical vacancies in the Paediatric Oncology Unit,” she said.

The Covid-19 response, coordinated at Livingstone Hospital, was also severely curtailed due to staff shortages.

The hospital is the designated Covid-19 centre for the entire western part of the province, serving about two million people.

According to a memorandum addressed to the Department of Health, there will be a maximum of four ICU beds available for Covid-19 patients. The memorandum points out that beds will be limited and adds that, due to no money available for overtime, there will not be a full-time doctor on duty after hours in the Covid-19 ward created in the hospital’s basement.

The Eastern Cape has one of the highest death rates in the world, more than 500 per 100,000, but last week provincial health spokesperson Sizwe Kupelo said a report detailing the causes of these deaths had not been presented to the department yet. The report was commissioned by the department and drawn up by one of its own doctors.

Hospitals have battled these staff shortages for many years with the provincial cost-containment committee being blamed for delaying appointments by more than a year in some instances. According to correspondence seen by DM168, this committee will, after delaying appointments for a year, then inform doctors that it is not filling the post as posts are deemed unnecessary and unfunded after being vacant for a year.

Last week, Zungu, who has been called back to the national Department of Health, issued a memorandum returning the power to human resources delegations at hospitals to make appointments if such appointments were approved by the provincial cost-containment committee.

Highly placed sources inside the national department, however, said they were not aware of the operations and authority of this cost-containment committee.

The legacy of the cost-containment committee was felt most acutely this week as hospital sources told of the threats against clinical personnel who refused to admit a child with cancer because it was too dangerous to treat her because of the nursing shortage.

The child was later transferred to East London.

On 18 June, the provincial department sent its most senior spin doctor and head of the department of communications, Siyanda Manana, to restore calm. DM168

This story first appeared in our weekly Daily Maverick 168 newspaper which is available for free to Pick n Pay Smart Shoppers at these Pick n Pay stores.

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All Comments 33

  • Shocking and disgusting. Stupidity? Incompetence? Laziness? Sociopathy? All of the above? At the very least I would love to see a class action of culpable homicide brought against zweli mkhize by the bereaved parents.

  • This is nothing short of an absolute disgrace and a reflection of the management shambles that we have in this country. For goodness sake, why is this lackluster president so timid about getting proper managers into his government and why can’t he show any strength of character. Maybe there is none.

    • What about the lackluster oppositon parties who should be questioning and holding accountable the government for these crimes against humanity ie SA Citizens. They should be doing this in a highly public and noisy manner so that humanity clearly understands who is to blame and what they can do about it.
      Or maybe they are scared because deep inside they know that they won’t be any better at serving humanity themselves.
      Persons of integrity with a zealous will to serve are scarce and certainly don’t visibly exist in the ANC.

      • They do question. Trouble is the media, specifically News24 are totally anti the DA and pro ANC. How does a party get it’s message across if it is blocked by the media?

      • Lacklustre? My word, I find your observation astounding. In my experience, the DA does it’s level best to hold the ANC to account …to the point where many people moan about the DA spending too much time bashing the ANC and not enough time building their own political profile.

  • My first job was with the Eastern Cape DoH in 2003, the department was a disgrace then! We didn’t have equipment to do our work, only to discover at the end of that financial year there were unspent budgets because of ineptitude that could have been used. Despite being offered a job there I left for a trainee position at Anglo Platinum, best decision ever, at 21 I could see the disaster the department was!

    The problems in the department are not Mkhize’s legacy but rather the legacy of the ruling party. All deployees are only executing the mandate of the ANC, so anything that is wrong is sanctioned by their employer. Since all evidence has revealed everything the party has touched has failed (except for BBBEE compliance in these failed entities), we can safely conclude this was the intention from the beginning.

    Run the country to the ground so that the masses become powerless and dependant on the government, that way the leaders can have billionaires who rule over their subjects that will keep them in power “Until Jesus comes back”

    • That is the saddest thing of all in that no one has had the courage to stand up in all those years and simply say ‘we’re not doing our jobs and therefore letting our people down’. The next saddest ting is that the voters won’t change in case they end up worse off. So where do we go with this? Improvement is out of the question because it will mean having to admit to past failures.

      • Admitting to failure has been the curse that politicians in SA have inflicted on all of us. In recent times Mbeku’s Aids policies and Zuma’s theft have shown the way. So if the Pres is not tesponsible why should the pawns be.!???

  • This new angle to Mkhize’s inability to apply due diligence to his portfolio must be a slap in the face of those commentators who defended him early on when the Digital Vibes scandal came to the fore.
    One of the statements that was vehemently denied by a number of commentators was that the conundrum’s under the cover of the Disaster Management Act caused much more harm than the virus itself. Where are all these defenders of wonderful Mkhize now?
    And of course CR’s retarded and delayed response to handle this man is also duly noted. ANC politics is much more imlortant than a few lives and it will remain like that.

  • His first commitment is to cANCer. He was their KZN Treasurer General collecting looted funds not do long ago. I see cANCer is struggling to pay salaries, now that Zondo is chasing them.

  • There can be no doubt that in many places in South Africa even the most basic of basic health services cannot be fulfilled by the ANC. We can expect this to become the norm should the NHI be implemented. It’s really just another attempt to cover up serial failures of over 20 years and open another looting pot.

    • Come the next general election, the ANC “Trumpcard” will hinge undoubtedly on its triumph in beating the virus (well almost, maybe, soon), its successful interaction with the private sector (ie the Medical Aid schemes) and the promise of the imminent implementation of the NHI with free healthcare for all. And the 40% who bother to vote (inclusive of free tee shirts and food packs) will swallow it hook, line and sinker.

  • This is actually Mumbo Jumbo Gomba’s legacy. That woman should be charged with crimes against humanity let alone fraud and theft from Mandelas funeral as is the case. Her arrogance and vanity were on display as much as her incompetence and idiocy. Mabuyane is increasingly looking like what he is; an ANC cadre completely out of his depth. Ms.Zungu came,saw and ran away. Only Go G and Volkswagen actually did anything useful when ovid arrived.
    I admire you for your reporting on the Eastern Cape shambles Ms.Ellis but until this totally useless PEC and Health Dept are decontaminated i truly dont expect any improvement. I registered for vax on 1st day it opened but have yet to receive an appointment so i,m going to W.Cape to look after myself.

  • “The Eastern Cape has one of the highest death rates in the world, more than 500 per 100,000.” That is the number to be interrogated. Remember Covid numbers were low at start of Covid and a small adjustment made later because of dismal administration. Had report from family that villages are decimated there because of Covid. Covid reporting is like filling in a timesheet, if it isn’t directly Covid easy just to book it to excess deaths and keep Eastern Cape out of the spotlight.

  • It’s easy to blame the man at the top but the problem is unsolvable. Along with all the other SOEs, there are simple not enough people with the required skills and integrity to fill all the positions where they are needed. Can’t see this changing any time soon. Looking forward to the NHI!!

  • A Class action against the Minister in his personal capacity would be a sign to future conspirators of what awaits them if they too follow this path. Until there is personal accountability, nothing will change. And the longer it takes to prosecute Zuma and his cohorts, the longer the suffering of the people and the economy of this country. The time has come for CR to show true leadership and to grow some balls! Just my opinion.

  • Fixing a failed health and education system (excluding for now, all the other failed and failing SOE’s and associates) is far beyond the abilities, experience and competence of our cadre-deployed government! That’s why they make a huge noise about ridiculous and ineffective Covid regulations; town, suburbs and street name changes; new and ungovernable traffic law systems; supposedly updated but still useless cadastre systems etc.. etc.. Until these incompetent seat-warmers are removed and replaced by people that actually know what they’re doing, vey little is going to change!