South Africa

SCOPA HEARINGS

Gauteng Department of Health grilled about inadequate performance and poor financial management

Gauteng Department of Health grilled about inadequate performance and poor financial management
Nomantu Nkomo-Ralehoko (Gauteng MEC For Health). (Photo by Gallo Images / Luba Lesolle) | Tsakani Maluleke, SA's Auditor-General. (Photo by Gallo Images / Darren Stewart)

A month after being appointed as Gauteng’s health MEC, Nomantu Nkomo-Ralehoko believes her embattled department has a ‘fighting chance’ of addressing concerns raised by the Auditor-General and members of the Standing Committee on Public Accounts (Scopa).

Gauteng Health MEC Nomantu Nkomo-Ralehoko and senior health officials were in the hot seat at hearings by the Scopa committee on Tuesday in Kempton Park, where they answered questions about measures to correct poor performance and financial management. 

At the top of the agenda, committee members, led by chairperson Sochayile Khanyile, expressed concern at the impact of a fire that broke out at Charlotte Maxeke Hospital 19 months ago.  

Responding to this, the head of the department, Nomonde Nolutshungu, told the committee the hospital was almost fully operational, with progress made to date at 96%.  

“There has been a lot of progress in terms of infrastructural remedial work. In terms of the services themselves, we are now at a point where we can say the hospital is back at 96%.”  

Read more in Daily Maverick: “Devastating Charlotte Maxeke hospital fire was an act of arson — police forensic report”  

Accident and emergency units were now fully operational, she said. In the same breath, Nolutshungu said that although significant strides had been made, officials still had concerns about security as reports had revealed that the fire was an inside job, despite a new security company being hired six months ago.  

“We found that this was an internal job, from people who are targeting copper wires and working on the site. They have all the time to remove wires from the walls; sometimes it takes about three or four days for these removals. They have been found and arrested. 

“We have evidence of people who have been driving with these stolen items. A case has been opened with the Hillbrow police station, some of them were in jail for some time.”  

Committee member Busisiwe Mncube quizzed the officials about services which are not yet back in operation.   

“We do still have a challenge in relation to oncology, especially radiation oncology, which is about x-rays treating cancer.  

“There is a long waiting time for access to that treatment, not only because  of what has happened in Charlotte but because also we have only two of these types of treatments in the province. We are engaging intensively with the clinicians [and] professionals; we are in the process now of procuring portable treatment machines,” said Nolutshungu.  


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Medical negligence lawsuits  

Nkomo-Ralehoko was asked to list and estimate the value of the lawsuits up until 3 March in which the department was the defendant, and the progress made by 30 September in the finalisation of each lawsuit. 

In a written reply, the MEC revealed that matters listed as medical negligence brought against the department sat at R24-billion. 

“Further verification of matters was conducted from 1 April 2022 to 31 August 2022 and during this period, 347 matters were found to have been finalised in courts, but not captured as such in the financial records of the department. These matters have since been removed from the financial records of the department, resulting in a R2.7-billion reduction in the contingent liability of the [Gauteng Department of Health],” said Nkomo-Ralehoko.  

Read more in Daily Maverick: “More than quarter of SA’s municipalities are on brink of financial collapse, warns AG” 

Chairperson Khanyile probed the amounts spent on litigation and whether the department had plans in place to minimise the number of negligence cases.  

“What is the problem? Is it a case of negligence, lack of equipment… people in your hospitals… incompetence, is there a plan to retrain people?”  

Nkomo-Ralehoko said there was a plan, which includes mediation, which she said was one of the most successful methods to reduce cases of medical negligence.  

“We have a plan. Yesterday, we had a meeting on this issue. Another strategy is to strengthen our legal team. We also realised that we were weak… now we have a team that will work directly with quality assurances.” 

Accruals  

The committee further expressed concerns about money which the department had spent but not paid to suppliers and service providers. The chairperson argued that the practice, in previous administrations, brought the department to its knees. 

“That will never happen again. We don’t want anyone that will misuse our funds; we will not allow anyone to take us back into that dark hole, we are at a point where we verify each and every invoice, even… back to 2013.”   

Khanyile further questioned whether the accruals, which sit at billions of rands, would not affect the 2021/22 budget.  

Dr Steve Mankupane of the finance department moved to assure committee members that the accruals would not severely affect the department’s budget, as part of their plan included settling the accruals in small portions. 

“We are going to finance the accruals through a payment plan of a certain percentage so that they don’t affect our budget,” said Mankupane.  

Procurement irregularities  

Another committee member, Amanda de Lange, questioned officials about their inability to prevent procurement irregularities, including a 2020 scandal which saw PPE orders worth R500-million placed by the department.  

De Lange asked whether there was a plan to deal with bidders who failed to declare their interests and tax matters, and whether they were doing business with the state as was the case in 2020.  

The department responded that bid committees were not “up to scratch” but they were resolving this by setting up trained committees.  

“We have changed our controls and checklist, and we have a type of system that allows us to punch in the names of people tendering and get their directors,” said Mankupane.   

Consequence management  

Canada Matsaneng, the acting chief risk officer, admitted to difficulties bringing those implicated in wrongdoing to account, as they evade the system. 

“The majority of the senior people involved in these incidents… unfortunately, by and large, all of them are no longer here, so we can’t effect consequence management. If we have not been able to discipline somebody since 2012, we don’t have a fighting chance to do that today.”   

How do we get it right? 

Responding to a question on what the department needed to do to get this right, Matseneng said: “It’s an ethical culture; we are not a department of police, we are a department of health. We are supposed to be taking care of people, so there is an aspect of societal force on malfeasance and unethical behaviour that as a department we are ill-prepared to deal with today. 

“It’s a capacity that we are building with other law enforcement agencies as well as the Office of the Premier. But it is a work in progress, it is in its infancy,” said Matsaneng.  

Despite all the issues the department is grappling with, officials echoed similar sentiments to the MEC about the department being on the right track.  

“We are on the right path in terms of where we need to take this department — we really do have a fighting chance,” said Matsaneng. DM

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