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.