The head of the Eastern Cape Department of Health, Dr Rolene Wagner, has been redeployed to the provincial premier’s office with effect from Monday, 2 October.

The move has sparked outrage among public health activists and members of the medical fraternity who said Wagner was making progress in dealing with the systemic challenges in the province’s health sector.

Financial director Msulwa Daca has now been put in charge of the department, but the division of responsibilities remains unclear.

It is expected that Premier Oscar Mabuyane will explain the arrangement at a press conference scheduled for Wednesday.

Insiders have suggested the decision to move Wagner could be seen as an attempt by Mabuyane to create the impression that he’s cleaning up his government ahead of the 2024 elections. 

Ongoing crisis

While Wagner has had a series of successes since her appointment to head the department in August 2021, the provincial health sector has been stumbling from crisis to crisis, mostly due to the department’s dismal financial situation.

The department is beset by “runaway accruals” – money owed to service providers from the previous financial year. Earlier this year, this amount stood at R4.76-billion – roughly 17% of the department’s R28-billion budget. This dire state of affairs was inherited by Wagner.

Desperate department officials have been constantly putting out fires as service providers suspend services, leading to drug stockouts and long waiting times for orthopaedic services due to a shortage of devices.

Some officials say they “live in hope” that their power will not be cut as administrators must choose between paying for medical services or paying their municipal accounts.

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Employees’ compensation takes up 81% of the remaining budget, and for years, the spending of millions on a “bloated administration” has been slammed by opposition parties – and ignored by the provincial government.

Last month, the Office of the Premier flagged the vacancy crisis in the department, where more than 1,000 posts remain unfilled. These include nine CEO posts and several senior administrative positions.

Key hospitals in the province remain without permanent CEOs, including Frere, Nelson Mandela Academic, Livingstone, the Centre for Child and Maternal Health, Dora Nginza, St Elizabeth in Lusikisiki and psychiatric hospitals Fort England, Tower and Komani.

Senior administrative positions in governance departments also remain vacant.

Following a recent oversight visit of the provincial health committee, the Democratic Alliance’s Jane Cowley asked Health Minister Joe Paahla to immediately place the province’s health department under administration. 

Phaahla visited the province two days later and said it was “too early” to do so.

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The department has faced a real crisis for some time as its R49-million debt to oxygen and gas supplier Afrox is putting patients at risk. Several smaller payments have been made to the service provider, but the debt is growing. 

The health department is technically bankrupt.

On Friday, a damning report on the state of governance inside the department was issued by the Auditor-General. Findings included a material irregularity that was flagged because of a failing patient record management system.

The department has also failed to meet targets to reduce neonatal and maternal deaths in its facilities.

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“Record-keeping [remains] an issue at health for medical records. This has [an] impact on the department [that is] unable to defend itself on medical litigations. Team is assessing a possible harm to the institution and a material irregularity on unavailability of medical records,” said the Auditor-General.

The AG’s report also flagged the Eastern Cape Health Department for failing to reach its target of at least 26% of clinics passing the ideal clinic standard. Only 21% of clinics (153 out of 733) are conforming to this standard.

“The state of clinics at OR Tambo district may not meet the needs of primary health care as only 5% (7/148) of clinics met the minimal standard,” the report continued.

‘Turnaround was already evident’ under Wagner

Public health advocates, academics and doctors working in the field have implored Mabuyane to allow Wagner to implement her plans for the department. 

In a letter signed by 129 members of the medical fraternity, the group wrote:

“Dr Wagner is known and respected in the Public Health community for her leadership of health systems strengthening and turnaround strategies in the health sector, particularly in the Eastern Cape, which have earned her and her team numerous accolades and awards.

“The inability to fill these posts, however, links to funding limitations that have made appointments impossible. These vacancies pale in light of the fact that, as recently reported at the Rural Health Conference, over 13,500 healthcare workers were appointed in 2022, placing them at rural facilities and other priority sites.

“Furthermore, between April and July 2023 alone, it has been reported recently, over nine thousand appointments were made, of which 1,390 are said to be permanent employees, and 7,647 contract appointments.

“These figures illustrate the magnitude of the task Dr Wagner and her team have had to address since her appointment in August 2021, at the height of the Covid pandemic.

“Other departmental achievements under her leadership, to name just a few, include the widely reported successful court battle that curtailed the haemorrhage of funds lost to medico-legal settlements (an estimated total of around R1.5-billion further loss has thereby been averted), the roll-out of a digital health record system to 26 hospitals and three EMS units, which saves the department around R45-million annually; and the elimination of unauthorised expenditure of the budget vote and the reduction of irregular expenditure from around R200-million in 2020/21 to under R6.7m at the end of 2022/23.

“[T]he complexities of the Eastern Cape health system, accumulated over decades, in just two years, but that the turnaround already evident under her leadership is indeed remarkable, and deserves and requires sustained support and commitment by all role players. 

“Furthermore, in the face of imminent budget cuts and drastic austerity measures, as signalled by Finance Minister Enoch Godongwana, health departments and their staff across the country, urgently require stability and certainty of leadership. 

“Destabilising Eastern Cape health leadership, which has achieved remarkable successes in a relatively short period of time, will endanger these and future achievements, as well as severely undermine staff morale, and will directly contribute to deteriorating levels of service delivery.

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“We therefore ask you to reinstate Dr Wagner in her post as HOD and provide her with the necessary support to continue implementation of the EC Department of Health’s turnaround strategy. 

“If you do feel that there is sufficient cause for concern about underperformance or maladministration to warrant her removal at this crucial point in time, we urge that this be preceded by a thorough and transparent review, including what steps have been taken to raise and remedy these in the past,” the letter reads.

Added support

The Rural Health Alliance added their support, calling on the premier to reverse the decision and saying that any decision to remove Wagner from her position would have a detrimental effect on the roll-out of health services in the Eastern Cape. 

“The Rural Health Alliance calls on the Eastern Cape government to urgently rethink its decision on Wagner.”

The chairperson of the Rural Doctors Association of South Africa, Dr Lungile Hobe, said: “Dr Rolene Wagner is not the problem. The Eastern Cape has systemic challenges that need systemic solutions. We are very worried about the Eastern Cape. To get a turnaround in this province we need continuity rather than changing new management.” 

The statement continues: “Wagner and her team have been systematically juggling different priorities needed to ensure that service delivery continues, and still address underlying root causes such as the depletion of funds through medical litigation.

“This has included bringing in measures to manage massive accruals from previous years and stabilising the dire financial situation of the department. 

“Part of the dire financial situation that the department finds itself in is because of R1-billion in damages for historical claims that it had to pay out. By launching an integrated medicolegal strategy, Wagner’s team prevented the department from losing a further R2-billion in these claims, curtailing the costs to under R500m.

“This must also be seen in the context of the recent austerity measures introduced by the National Department of Health, which will see the R1.1-billion public wage bill being paid out of the current Eastern Cape health budget.

“The Rural Health Alliance calls on the Eastern Cape government to reappoint Wagner and to reconsider the healthcare needs of the six million people in the province who need equitable access to quality healthcare.” DM