Delayed construction work, poor maintenance, water shortages, and surgical backlogs are some of the problems patients and healthcare workers face at Boitumelo Regional Hospital in Maokeng township in Kroonstad.

This is despite the Free State Health MEC Montseng Tsiu parading it as one of the hospitals that received ‘ideal status’ in the 2021/22 financial year.

In her budget speech, Tsiu said the department started implementing “the ideal hospital framework in 2019 in preparation for the NHI (National Health Insurance) accreditation”.

“In the past two financial years, the Covid-19 pandemic has impacted negatively on the performance of our health facilities and the related assessment outcomes. However, in 2021/22, the Boitumelo, Bongani, and Dihlabeng regional hospitals, as well as Pelonomi Tertiary and Universitas Academic hospitals, achieved the ideal hospital status,” said Tsiu.

Achieving ideal status includes, among others, having adequate stock of medicines and equipment, as well as maintaining buildings and hospital grounds.

‘Lost hope’

Spotlight visited the hospital after patients and opposition party members in the province sounded the alarm over conditions at the hospital. DA councillor in the Moqhaka Municipality, Mbali Mnaba tells Spotlight she is still shocked at what she had witnessed at the hospital during an oversight visit.

“This hospital has so much potential, but the government does not take people seriously. Members of the community have lost hope in government,” she says. 

Boitumelo Regional Hospital is the biggest hospital serving public sector patients in the northern parts of the Free State in the Fezile Dabi District.

An empty reception area at Boitumelo Hospital. (Photo: Refilwe Mochoari/Spotlight)

‘Construction in progress’

Spotlight visited the hospital on 29 October 2022. From the street, it looks like a neat and well-maintained public health facility, but once inside, a different picture emerges.

At the back of the hospital, the grounds are unkempt and there are half-built structures, leaking roofs that look as if they are about to collapse and non-operational theatres with signs that read — construction in progress.

Upon entering the hospital’s administration area, we found ourselves in an empty hall with clean and polished floors. As far as we could tell, there were no staff members to assist patients. Brand new leather couches stood in a corner on top of each other while patients were sitting on the pavements outside the door, waiting to be assisted.

Incomplete construction of patient wards at Boitumelo Hospital. (Photo: Refilwe Mochoari/Spotlight)

‘Theatres don’t work’

One nurse Spotlight spoke to says the poor hospital infrastructure affects them as healthcare professionals because patients suffer and they have to bear the brunt and answer to complaints.

“There are not enough beds and we feel very sorry for the patients, especially those ones who need orthopaedic surgeries. Theatres do not work. Everything is a mess. Windows are broken in existing wards. Sometimes when it rains, patients find themselves freezing.” He says rain also comes in through the broken windows.

“Air conditioners do not work. There are no CCTV cameras for security purposes and there have been instances where we have been attacked and nothing can be done because culprits cannot be identified,” he says. “Another thing is that the additional wards [once finished] would be so helpful if management of the hospital was serious about patient care.”

Incomplete patient wards seen by Spotlight show no signs of any recent construction work having been done.

According to another hospital worker, the construction of the new wards has been a “non-starter” for the past five years since he started working there.

“I have been working at this hospital for the past five years and I have never seen work being done on it. They don’t even try and I really don’t know if it will ever be completed,” he said. “This site of the hospital is just abandoned and hospital management is relaxed.”

Theatres closed and not operational at Boitumelo Hospital. (Photo: Refilwe Mochoari/Spotlight)

Waiting for surgery

The hospital’s theatres have not been fully operational since May 2022. According to DA spokesperson for Health in the Free State, Mariette Pittaway, this has resulted in a backlog of orthopaedic surgeries, which is currently at 2,947 for the whole province.

Health minister Dr Joe Phaahla, earlier in response to a parliamentary question, said that due to these backlogs, patients in Free State hospitals, including Boitumelo Hospital, can wait from three months to four years for surgery.

Pittaway says they receive complaints about these backlogs daily. “Patients have been waiting for orthopaedic surgeries such as hip replacements for months and, in some cases, for years and it impacts the lives and livelihoods of these patients severely. Many are elderly and living with extreme pain, while others lose jobs.”

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Years of ‘revitalisation’

Boitumelo Hospital was identified by the Free State health department as a priority revitalisation site and the upgrading of the hospital started in 2009. Since 2011, however, construction and upgrades appear to have halted.

Spotlight requested comment from the Free State Department of Health on the infrastructure issues and an update on its future plans for Boitumelo Hospital, but did not receive a response by the time of publication.

Some parts of Boitumelo Hospital where constructed stopped. (Photo: Mariette Pittaway)

Pittaway says legislators are also in the dark since there have been no updates or briefings to the health committee she serves on.

The hospital has been included in the hospital revitalisation programme, a nationally-funded programme. Based on the last publicly available information from the Free State health department on this project, by 2011 the completed areas that were part of the programme include the nurses’ home with 64 rooms, a doctors’ quarters, an out-patient department, psychiatric, and maternity units. However, there are still no completion dates for upgrades such as the new patient wards, new kitchen units, new operation theatres, gynaecology, and ICU.

Even the hospital management, until earlier this month, was seemingly in the dark. 

Electrical boxes in one part of the hospital. (Photo: Mariette Pittaway)

What hospital management says

According to Dr Kabelo Mahasa, clinical manager at Boitumelo Hospital, the last information they received this month relating to the revitalisation programme was that a new contractor has been appointed.

“I can confirm right now that R6-million has been allocated to work on the operation theatres that are not working. We have in total six theatres and only one of them is working, so since a contractor has been appointed last week [end October], construction is expected to commence as early as possible, says Mahasa.

He could not provide reasons for the years of delays and referred Spotlight to the health department.

When Spotlight asked about important equipment and air conditioning systems in theatres that are not working, Mahasa says, “Remember, these are not ordinary air conditioning systems, these are hospital theatre systems which are much more complicated than the ones you use in homes. It is not overnight work or something that can be fixed overnight. But I am confident to say that a contractor is appointed and work will be completed soon.”

Mahasa says that even though there is only one working theatre, they are able to perform approximately 20 surgeries per day.

“In that theatre, we do the emergency caesarean sections, all operations such as appendixes including orthopaedic surgeries. So we are under extreme pressure, but even under those conditions, we still deliver,” says Mahasa.

“I can confirm that indeed we do set aside orthopaedic surgeries due to the nature of emergencies we often get at the hospital,” he says.

Free State Health MEC Montseng Tsiu. (Photo: Free State Health/Facebook)

The department’s plans on paper

Health MEC Tsiu in her budget speech earlier said R741.2-million has been allocated for health facilities (infrastructure) management in this financial year.

Tsiu said her department will ensure health facilities regain their ideal status after the impact of Covid-19 on assessment outcomes. “This, we will achieve by making critical appointments, such as operational managers, cleaners, and pharmacy assistants. Much of our effort will also go into conducting ongoing maintenance, which has suffered partly because of funds being reprioritised in response to the Covid-19 pandemic,” Tsiu said.

Referring to the Ideal Hospital numbers, she said since the programme started in 2019/2020, “13% of the district hospitals achieved ideal status, which increased to 50% in 2020/21 and declined to 44% in 2021/22 due to the Covid-19 pandemic. The department will focus on continuous quality improvement to ensure we are NHI-ready.”

Boitumelo Hospital does not feature on a list of facilities due for refurbishments, renovations, and upgrades in this financial year that Tsiu provided in her speech.

A matter of urgency

The latest tabled annual report (2021/22) for Free State health, highlights resolutions by the Standing Committee on Public Accounts (Scopa) which read: “Renovations and refurbishments at the Boitumelo Regional Hospital are to be completed as a matter of urgency, as the project completion date is long overdue.”

The department’s response to this was that they have met with the Department of Public Works in the province as well as the consultants to resolve outstanding issues regarding the BOQs (the record of items of work for the tender) and specification so that the procurement process can begin before the end of the 2021/22 financial year. This meeting took place in January.

The department said in the report that at the time, the work at the hospital was 75% complete.

In its annual report, the department notes that the huge maintenance backlog at health facilities continues and that it is now prioritising the maintenance of existing facilities. However, the department says it is limited in what it can do “due to budget constraints as the provincial equitable share allocation is insignificant”.

“The department, by and large, relies on the conditional grants for projects, including for the maintenance programme,” the annual report reads.

The health department acknowledges in the report that a lot of work still remains and progress in addressing maintenance backlogs has been slow — not only at Boitumelo Hospital but across health facilities. Apart from budget constraints, a lack of maintenance personnel in districts and the department’s infrastructure unit was also identified as a problem. To beef up capacity, the plan was to establish a “panel of professional service providers” (PSP) and contractors in the 2021/22 financial year. It is not clear if this panel had been established. The plan was also to appoint additional technical personnel. DM

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