The past two weeks have seen health professionals across South Africa call for the exemption of public hospitals from rolling blackouts. On Friday, 30 October, Minister of Health Dr Joe Phaahla said that 37 hospitals have been exempted, with efforts underway to ensure the exemption of all public health facilities from scheduled outages.

Speaking at a media briefing, Phaahla acknowledged that intensified loadshedding over long periods was impacting the ability of hospitals to provide quality health services. While many health facilities have generators for backup power supply, these alternative energy sources are not equipped for prolonged blackouts.

“We want to make sure that the over 300 hospitals, and a lot more health centres, which we have in the country, should all be exempted,” said Phaahla.

“[This is a] little bit of progress – we would have wished for a lot more – but we’re going to be really following this up around the clock, to make sure that medical facilities are exempted from continuous load shedding.”

As of Tuesday, 27 September, South Africa had experienced rolling blackouts lasting a record 475 hours – the longest streak on record, according to a News24 report.

Of the hospitals that have been exempted from rolling blackouts:

• Nine are in Gauteng;
• One is in the Free State;
• 14 are in KwaZulu-Natal;
• Four are in Limpopo;
• Five are in the Eastern Cape; and
• Three are in the Western Cape.

In the Northern Cape, three hospitals are awaiting a response from Eskom regarding their exemption. While in Mpumalanga, the Witbank and Rob Ferreira hospitals are being prioritised for exemption.

Impact on healthcare

Daily and prolonged power disruptions put services and equipment in health facilities at risk, said Phaahla. In large facilities where backup power sources are unable to support lighting, the safety of staff is also affected.

“When staff are called for emergencies at night, if there is load shedding it means the generators and UPS [systems] can’t keep the whole area [lit]… and we know that there have been various risks of security where some of our health workers have been harmed,” he said.

Professor Adam Mahomed, the head of internal medicine at Charlotte Maxeke Johannesburg Academic Hospital, launched a petition on Tuesday, 20 September, demanding the exemption of all Gauteng hospitals from rolling blackouts. He said: “UPS batteries in Neonatal Care Wards and other ICUs do not have enough time to recharge between power cuts during load shedding, which is fatal for infants and the most vulnerable of patients.

“Even where hospitals do have generators, they cannot power the entire hospital, so outpatients, for example… will sit in total darkness requiring healthcare professionals to use their cellphone torches in order to examine them.”

One of the biggest knock-on effects from rolling blackouts is the growing backlog of elective surgeries at public hospitals, Maverick Citizen previously reported.

Read in Daily Maverick: “Exempt public hospitals from rolling blackouts, health professionals plead”

In Limpopo, health officials were recently forced to cancel elective surgeries for a week, due to Stage 6 rolling blackouts, according to a News24 report. The surgeries could only resume when outages eased.

“Emergency surgeries cannot be performed timeously because of [rolling blackouts]. As it is, after Covid, the number of admissions and severity of disease have increased exponentially, putting a further strain on an already stretched healthcare system,” stated Mahomed in his petition.

At Friday’s briefing, Phaahla said that the backlog of surgeries at hospitals was not attributable to rolling blackouts alone, but also to the impacts of the Covid-19 pandemic. There are currently between 170,000 and 180,000 backlogged surgeries across the country.

“A big number of those… were recorded in the Western Cape, and all provinces did report somewhere between 5,000 and 10,000 backlogs in cataract [surgery], in orthopaedic knee replacements, hip replacements, [and] various forms of elective surgery,” he said.

According to Dr Sandile Buthelezi, Director-General of the Department of Health, there have been no reports of deaths directly attributable to rolling blackouts.

Dr Sandile Buthelezi, the Director-General of the Department of Health. (Photo: Wits University)

Hospital exemption process

The exemption of hospitals across provinces remains a “work in progress”, according to Phaahla. It involves collaboration between the Department of Health, Eskom, provincial health departments and certain municipalities.

“We’ve set up… a high-level team that is going to meet every week. On the Eskom side, it’s led by the group executive for distribution, and on the department side, it’s led by the [director general],” said Buthelezi. 

Provincial departments of health are expected to produce a consolidated list of health facilities that need to be exempted by Wednesday, 5 October, according to Phaahla.

Factors such as patient load, the provision of specialised services and the presence of medical equipment to be safeguarded, will be taken into account when prioritising health facilities for exemption from scheduled outages.

“This… will prioritise central hospitals… very key in referrals of complicated cases and do a lot of life-saving interventions for critically ill patients, regional districts hospitals, [and] the 24-hour community health centres and clinics,” said Phaahla.

In areas where Eskom provides electricity directly, the power utility will work with the Department of Health to exempt health facilities from rolling blackouts. Where there are secondary suppliers of electricity such as municipalities, Eskom will need to work with local entities to ensure the instalment of dedicated power lines for hospitals.

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“[Eskom] emphasised that even when they supply [power] directly, they have to work around some situations where our facilities share the lines and substations… with other communities and other neighbouring structures,” said Phaahla. “In safeguarding our facilities, there is work which will have to be done to separate them.

The department has made a commitment to Eskom to reprioritise funds and to find ways to contribute where additional cables and alternative power lines need to be installed.

“We [will] work together to mitigate against the cost… and that’s why we are also engaging colleagues in the National Treasury, because we believe this is a life-saving investment, which we have a duty to make sure that we can do,” said Phaahla.

Charlotte Maxeke Johannesburg Academic Hospital in Parktown, Johannesburg. (Photo: Gallo Images / Papi Morake)

Mixed energy supply

The public health system will continue to depend on the Eskom grid for the majority of its power supply, said Phaahla, with diesel generators being used for backup power. However, the department aims to include renewable energy sources in the “energy mix” of facilities.

“We are… working on a phased approach to invest in renewable energy through installation of solar power facilities… at all our health facilities,” he said. “There is a feasibility study that has been undertaken by our team – from our technical infrastructure team and also finance team – to look at how… we can phase the introduction of this energy mix, based on budget availability.”

In Mpumalanga, the consumption of diesel and oil has skyrocketed at many facilities due to ongoing rolling blackouts, with some having already exhausted their 12-month supply budget for generator fuel and maintenance.

“Virtually all provinces are reporting that their budgets for diesel are getting exhausted much earlier, because this was meant just for emergency backup. Now, they have to run [generators] sometimes for eight to 12 hours… [a] day,” said Phaahla.

“We’re going to have to engage with our colleagues in treasury to see how we can reprioritise to support these facilities, because it’s not out of poor planning. This is an unforeseen and unavoidable expenditure, which we need to find ways to… mitigate.” DM/MC