Sibusisiwe Ndlela is an attorney at SECTION27. SECTION27 is part of the Eastern Cape Health Crisis Action Coalition.

Compounded by Covid-19, the understaffing of doctors and nurses in Nelson Mandela Bay’s Livingstone Hospital is one that the provincial Department of Health has long been warned about. 

Most recently, in a report following an investigation into conditions at healthcare facilities in the province, the Office of the Public Protector found that “the administration of health by the [department] at Livingstone Hospital does not accord with the obligations imposed by the Constitution and the law”. 

Acute staff shortages, the report found, were one shortcoming of the health system that contributed to the department’s failure to meet its constitutional and statutory duties. In remedial action, the Deputy Public Protector recommended that the head of the provincial Department of Health was to ensure that the filling of other critical positions at the hospital was to be prioritised.

Despite this and other public criticism, the process for the appointment of medical personnel in Eastern Cape remains shrouded in secrecy, most notably, the criteria applied by the Provincial Cost Containment Unit to approve the appointment of medical personnel. For example, a senior health official in the province told us how, in or around May 2021, they had interviewed candidates for a number of vacant positions. They submitted a list of recommended candidates to the Provincial Cost Containment Unit. Thereafter, in the absence of any explanation, not a single appointment was made by the Provincial Cost Containment Unit.

No access, no transparency

In October 2020, in terms of the Promotion of Access to Information Act, the Eastern Cape Health Crisis Action Coalition (a broad coalition including SECTION27, where I work) requested access to the department’s records which included the plans that are in place to provide for Covid-19 related interventions at Livingstone and Dora Nginza hospitals.

This request for access was ignored and effectively refused.

We subsequently filed an internal appeal in respect of the refusal of access. To date, we have not been furnished with these records. We know the documents exist because they were referred to in intervention plans presented by the provincial health department to the Health Committee in the Eastern Cape Legislature in July 2020. However, the plans have not been published or made available to us. Without access to these plans, we cannot assess or monitor their implementation.

When we receive reports of the understaffing and dire conditions at Livingstone Hospital, now compounded by Covid-19, our hearts go out to the frontline workers who place their lives at risk to provide care in the most trying circumstances. Despite the sacrifices they make by placing their lives on the line, the provincial health department has failed to meet them halfway by providing even the minimum number of staff required.

The Eastern Cape Department of Health must prioritise the appointment of medical personnel and put in place effective intervention plans to address systemic issues in hospitals. (Photo: Denvor de Wee / Spotlight)

An old crisis

This is not the first time we’ve attempted to engage constructively in addressing the healthcare crisis in the province. We wrote to the national and/or provincial departments on four separate occasions between May to June 2020 to draw their attention to the collapse of healthcare services in the province. In addition, in June 2020, with the Treatment Action Campaign, we marched to the head offices of the department where we handed over a memorandum lamenting the decades of dysfunction in the province’s public healthcare system, which is now exacerbated by the Covid-19 pandemic. We implored the department to make public its Covid-19 response plan together with its revised staffing plan.

More recently, the closure of the Rev Dr Elizabeth Mamisa Chabula-Nxiweni Field Hospital in Nelson Mandela Bay is not just deeply regrettable but showed a misalignment between departmental spending and the actual needs on the ground.

The field hospital, the result of a public-private partnership between the department and Volkswagen South Africa, was set up to relieve the burden on the Livingstone and Dora Nginza hospitals during the pandemic. The field hospital opened in June 2020 during the second wave of Covid-19 and closed about a year later.

For the 2021/22 financial year, as part of its Covid-19 response, the provincial health department reprioritised about R640-million from its capital assets budget towards additional expenditure for field hospitals. However, the provincial health department has since indicated that these funds have been reallocated towards renovating older buildings that house health facilities to make provision for additional bed space.

We acknowledge that additional bed space is important, but without doctors and nurses to care for patients occupying these beds, the intention rings hollow.

A dangerous cycle

The severe understaffing, together with the failure to fill vacant medical personnel posts, not only undermines the rights of individual healthcare users but also undermines the entire provincial healthcare system. With austerity measures as fiscal policy, the Eastern Cape health budget in 2021/22 has been reduced in nominal and real value compared to the 2020/21 financial year.

By December 2020 the provincial health department had paid out almost R1-billion in medico-legal claims, brought about by, among others, understaffing, which may mean legal liability when harm is caused to patients. This creates a perpetual cycle where substandard care is meted out because of understaffing and it attracts huge medico-legal claims which, when paid, undermine the provincial health department’s ability to fund appointments of medical personnel in critical posts.

This dangerous cycle can, however, be interrupted. One way to do this is to prioritise the appointment of medical personnel and putting in place effective intervention plans to address systemic issues in hospitals.

For this reason, we call on the superintendent-general of the Eastern Cape Department of Health to urgently appoint additional medical personnel necessary to provide quality healthcare to patients in that province in a manner that vindicates their constitutional and statutory rights.

Similarly, we call on the superintendent-general to make available the records on the intervention plans to the Dora Nginza and Livingstone Hospitals; and to make the staffing decisions and appointments more transparent. This transparency will help all stakeholders in health to make more informed judgments and suggestions on how best to tackle this long-standing issue and to hold the department accountable in the execution of its duties. DM/MC

Spotlight is published by SECTION27 and the TAC, but is editorially independent, an independence that the editors guard jealously. This is an opinion article and the views expressed in it are not endorsed by Spotlight.

This article was produced by Spotlight – health journalism in the public interest.