On Friday, 3 March, the Medical Advisory Committee (MAC) of Chris Hani Baragwanath Academic Hospital (CHBAH), the largest hospital in South Africa, took an unprecedented step and sent a letter directly to Gauteng MEC for Health Nomantu Nkomo-Ralehoko and head of the Gauteng health department Dr Nomonde Nolutshungu, requesting an urgent meeting at 9am on Monday, 6 March at the hospital.

The letter was also copied to Gauteng Premier Panyaza Lesufi, who when he assumed office pledged that he would fix township hospitals.

“We are serious about health. Hospitals must not be the way they are now. We are starting with [fixing] the hospitals in the townships, as part of our broader township development agenda. We want to see a 360-degree change,” said Lesufi.

Six months later, health workers say they see little evidence of improvement in management.

Read more in Daily Maverick: “Nomantu Nkomo-Ralehoko is appointed Gauteng health MEC – mainly for financial expertise rather than health knowledge”

The MAC is made up of senior clinicians and senior allied health professionals, as well as senior management. In their letter, signed by the chairperson, Professor MT (Billy) Ramokgopa, the MAC members challenge the Gauteng health department’s decision to terminate the employment of 737 fixed-term contract employees who have been employed under the Covid-19 grant at CHBAH since 2020.

The letter points out: “These employees have over the past three years provided critical services to Covid and non-Covid patients and have gone a long way in alleviating the chronic staff shortages that have always existed at CHBAH.”

It adds that their departure will “leave a huge void and severely compromise clinical health services… Ultimately, it is the patients and communities we serve that stand to suffer the consequences of this decision.”

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The letter notes that their employment costs R193-million and calls for all 737 to be “retained and absorbed permanently in the current hospital staffing establishment”.

The letter comes on the eve of the Health MEC’s budget speech on Thursday and only a few days after the publication of the national Budget that announced further cuts to the health budget, including in infrastructure.

But it also coincides with reports from frustrated doctors, working across hospital departments, that paint a picture of an institution in terminal decline with doctors at their wits’ end about conditions in the hospital.

Professor Rudo Mathivha, the head of the ICU, has been increasingly desperate in her pleas for the hospital to be made safe for patients and staff. She and other health workers there have spoken out about the conditions, listing the problems as including:

1. “HR shortages in the clinical areas, yet GDOH [Gauteng Department of Health] plans to cull posts there further come March 31, 2023.
2. “Shortage/stock-outs of essential medications because the agents that got the tenders to supply cannot meet the demands.
3. “Shortage of basic essential consumables like IV giving sets; IV fluids preparations.
4. “Endless puerile debates and posturing by people called ‘chief engineers’ by DID [Department of Infrastructure Development] in authorising repairs on time.
5. “An aloof GDOH Central Office that handles matters top down if they handle them at all.”

Mathivha laments: “We have yet to meet the ‘new’ MEC for health face-to-face as workers, yet she is making rulings that impact on our capacity to provide service to our patients. The same goes for the DDG HR and Corporate Services and DDG Hospital Services.”

The reason for this may be that the Gauteng Department of Health remains in freefall. On Sunday, the department announced the resignation of its head, Dr Nomonde Nolutshungu, “at the end of March due to health reasons”. Nolutshungu was appointed less than a year ago, in April 2022. It also announced the resignation of three tertiary hospital CEOs, including at CHBAH.

Gauteng and national health departments respond

In response to questions Motalatele Modiba, head of communication for the Gauteng Health Department, told us that “the senior management at GDoH met with the management at CHBAH together with the MAC for the better part of Monday, 06 March 2023” and that they had “committed to fully support CHBAH including other facilities during this period to ensure that the process to fill the posts runs smoothly.”

He claimed that “the continued appointment of [some] Covid-19 contract staff for the 2023/24 financial year will be based on critical, prioritised and urgent service needs at each hospital on the budget allocated to the Department.”

Modiba said that all the affected staff were aware that their contracts would expire on 31 March 2023. This, he said, had been “discussed and agreed upon in 2022 with all affected parties, including the CEOs of hospitals and organised labour.”

Modiba said that “the reduction of the Cost of Employee budget for the 2023/2024 financial year to R600-million requires the department to reprioritise critical posts in line with its needs at service platforms.” 

“The Department has communicated the budget cut to all the CEOs and organised labour. All hospitals have submitted their needs according to their prioritisation. This is currently being processed.

“Given competing priorities across various service platforms it becomes important to reprioritise the capacity needs so as to optimise the limited resources. We need to also take into account that there are other health professionals like the post community service doctors who are our bursary holders that must also be considered in this process.”

According to Modiba, during the meeting on Monday, “The GDoH Management was able to provide clarity on how the grant will be utilised including the allocation to other institutions. There was an agreement on prioritisation of clinical posts across service platforms and that due process needs to be followed to advertise the posts in line with allocated resources. The process will be fast tracked so as not to negatively impact on the facilities.”

Last night Dr Percy Mahlathi, the Deputy Director-General in the NDOH responsible for Hospitals, Tertiary Services, Human Resources, EMS and Infrastructure, told Maverick Citizen the minister of health “is very concerned. The Department has done background work collating information from across the country and (is) actively engaging with the Treasury.” He suggested that further developments might be forthcoming. DM/MC