South Africa


Eastern Cape Health Department slammed for ‘acute systemic deficiencies’ at healthcare facilities

Trauma trolleys outside Livingstone Hospital's busy emergency unit in Gqeberha, Eastern Cape. (Photo: Shiraaz Mohamed)

Public Protector Busisiwe Mkhwebane has found that the Eastern Cape Department of Health’s administration at four public hospitals constitutes improper conduct and maladministration, and amounts to a violation of the Constitution.

Deputy Public Protector Kholeka Gcaleka on Wednesday revealed the findings of her office’s investigation into deteriorating conditions at Eastern Cape public health facilities.

The report was among 17 released. They covered several areas including housing, healthcare, Home Affairs issues and the management of municipal finances.

Gcaleka said the Eastern Cape health investigation, which began on 30 July last year, was founded on information brought to the attention of the Public Protector in media reports relating to poor conditions at hospitals in the province.

(See more coverage of the Eastern Cape’s healthcare crisis in Daily Maverick here and here.)

On 4 and 5 August last year, a team from the Public Protector’s office visited several health facilities in the Eastern Cape to conduct site inspections.

“The investigation revealed that the administration of health by the ECDoH (Eastern Cape Department of Health) at Nessie Knight, Mthatha, Livingstone and Uitenhage hospitals does not accord with the obligations imposed by the Constitution and the law,” said Gcaleka.

The report revealed that at Nessie Knight Hospital, the team observed “systemic deficiencies such as staff shortages, lack of adequate medical equipment, insufficient supply of PPE, poor physical infrastructure such as dilapidated buildings, lack of vehicles, lack of laundry services and poor supply of water”.

The Eastern Cape Department of Health failed to ensure adequate conditions for the “enjoyment, delivery and access” to effective healthcare services for the communities of Sulenkama, Mthatha, Gqeberha and Uitenhage.

Addressing the media, Gcaleka said: “Such failure by ECDoH amounts to contravention of the relevant sections of the Constitution, relevant sections of the National Health Act and the regulations… The conduct of the ECDoH constitutes improper conduct as envisaged in the Constitution and maladministration in terms of the Public Protector Act.”

Observations made at Mthatha Hospital revealed “acute systemic deficiencies”, including inadequate infrastructure, lack of a mortuary, shortage of human resources, lack of vehicles and inadequate medical equipment and machinery, the report said.

At both Livingstone and Uitenhage hospitals, staff shortages, deteriorating physical infrastructure and shortages of medical equipment and machinery were observed.

The same systemic deficiencies at each health facility were reiterated in submissions by the hospital management and in submissions by union representatives engaging with the investigation team, said the Public Protector’s report.

Remedial action

Within the 2021/22 Medium Term Expenditure Framework, the Eastern Cape Department of Health and, where necessary, in consultation with the Eastern Cape department of public works and infrastructure, as well as the Eastern Cape provincial treasury, must ensure the finalisation of several projects at Nessie Knight Hospital.

These include:

  • Construction of new residences for staff;
  • Installing water supply in residences;
  • Renovation of male, female and TB wards;
  • Installation of new ceilings in ward passage(s) as part of
    the main hospital building renovations;
  • Refurbishment of hospital equipment and installation of piped oxygen;
  • Sourcing additional funding from the provincial/national Treasury to pay creditors and critical service providers, including contractors on projects; and
  • Addressing shortages in human resources.

As part of the remedial action at Nessie Knight Hospital, the health department must ensure sufficient PPE is supplied within 30 days.

At Mthatha Hospital, the head of the health department must ensure that vehicles from other health facilities are reassigned for the benefit of this facility within 30 days of the date of the report and that a submission is made to the provincial treasury for assistance with the “settlement of medico-legal claims relating to the hospital to avoid the further attachment of the assets of the hospital, within 30 days”.

The report said the Eastern Cape Department of Health must ensure that the recruitment processes for vacant leadership positions at Livingstone and Uitenhage hospitals are finalised within 60 days, and that the filling of other critical positions at the hospitals must be prioritised. DM


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  • Reading this article provides a clear indication that the management problems are not going to be sorted out any time soon and it simply leaves me utterly defeated that anything will be achieved in the absence of proper and practical recommendations.