Thirty years since South Africa’s first post-apartheid election, many voters in the Eastern Cape are still exposed to shocking healthcare conditions. While a national-level political shift after the 29 May vote seems possible, political parties expect more of the same for healthcare in the province.

Spotlight put questions to six political parties on what specific solutions they are putting on the table for health in the Eastern Cape. Our focus was on getting beyond national-level rhetoric to get a clear sense of what concrete things parties promise to do to address some major problems in the province. We received responses from the DA, ActionSA and the EFF. None seems confident of removing the ANC from power in the province, alone or in coalition. In 2019, the ANC received more than 70% of the vote in the provincial election.

The ANC’s provincial spokesperson, Gift Ngqondi, the UDM’s representative in the provincial legislature, Nkosinathi Ndlodaka, and Nelson Mampofu, who represents the ATM in the provincial legislature, all failed to provide substantive responses despite being contacted several times by Spotlight.

Problems with emergency medical services 

The South African Human Rights Commission (SAHRC) painted a picture of emergency medical services (EMS) in shambles in a landmark report published in 2015. Nine years later, it seems little has changed.

This was confirmed when Eastern Cape health MEC Nomakhosazana Meth admitted in her 2022/23 budget speech that her department had failed to address the SAHRC’s recommendations. Her department blames the protracted EMS troubles on funding shortfalls, the poor state of provincial roads – which are riddled with potholes – and attacks on crew members.

Furthermore, the province is not meeting the national target of at least one operational ambulance per 10,000 people, now suspended health department spokesperson Sizwe Kupelo confirmed in November 2023. Although the ambulance fleet increased from 306 in 2018 to 439 in 2023, about 190 are grounded for repairs and services.

Lack of safety

The first hurdle in improving EMS services is the lack of safety and security in crime hotspots where EMS staff are often robbed, ActionSA provincial chairperson Athol Trollip tells Spotlight.

Since January 2024, about 20 cases of robbery have already been reported, according to AK Munilal, the director of EMS in the Eastern Cape. In the most recent incident, at the beginning of April, two personnel were mugged at gunpoint outside the Max Madlingozi Clinic in Gqeberha.

“Unless crime and violent criminality are addressed, EMS will continue to underperform,” says Trollip, who also blames poor human resources management and waste of resources for the shortages of EMS staff. He says the department doesn’t have the money to employ them.

Poor roads

EFF provincial secretary and health portfolio committee member in the legislature, Simthembile Madikizela, flags poor road infrastructure as another reason EMS services aren’t able to serve rural areas.

Madikizela says the poor roads contribute in part to many people losing their lives trying to get to healthcare facilities. “I find it embarrassing that sick people have to hire private transport at an exorbitant price to get to health facilities,” he says.

It seems odd, Madikizela says, that Eastern Cape government departments are not managing to fix the roads. “[I]n this case, the Department of Public Works and Infrastructure should ensure that the roads leading to health facilities are in good shape.”

‘Outsource repairs’

Jane Cowley, who represents the DA on the health committee in the legislature, says outsourcing the repair of ambulances could get them back on the road faster.

“Currently, the ambulance takes about 100 days at state garages to be repaired, which is insane. We have mechanics in every town and village that can work on vehicles. All that we need to do is to outsource the services to private businesses, which could be a solution to the province’s ambulance shortage… This means we can also up the staffing for the ambulances, because what good is having ambulances if there is no one to drive them?” she says.

The problem of medico-legal claims

Slow ambulance response times, coupled with high vacancy rates for clinical and non-clinical staff, are fuelling the high number of medico-legal claims against the province’s health department, says Cowley.

She describes the medico-legal problem as a “financial disaster” that is draining the department’s coffers and has resulted in services at hospitals and clinics deteriorating dramatically over the past few years. “The claims have depleted the department’s funds to the extent that it starts every financial year with a substantial amount of accrued debt from previous years,” she says.

ActionSA’s Trolip says medico-legal claims in the province are “a racket” in which “many people are making a fortune”.

The EFF’s Madikizela makes a similar argument. “Some of the claims are false claims by a syndicate of law firms in conjunction with the department staff. Some of the law firms are defrauding the department by submitting fraudulent claims, and those are the things that need to be tackled.”

The exact scale of fraud relating to medico-legal claims in the province is not known, but some cases have made headlines and the Special Investigating Unit is looking into the issue in several provinces, including the Eastern Cape.

The Eastern Cape often ranks at or near the top for the number and value of medico-legal claims against health departments. Between 2014/15 and the end of February 2021 the department paid R3.4-billion for these claims.

However, in February 2023, the department had a significant victory when the Bhisho High Court ruled that the department no longer had to make upfront lump-sum payments in certain medical negligence claims. It also ruled that the department may provide the necessary medical care instead of paying future medical costs. Spotlight previously asked the department for the latest data on medico-legal claims in the province, but did not receive a substantive response. We thus don’t know whether the ruling has so far had any beneficial impact on the department’s thinly stretched finances.

How to reduce medico-legal claims

According to Cowley, the bulk of medico-legal claims relates to cerebral palsy caused by birth complications. “It is pregnancy and birth complications that cause cerebral palsy, and 99% of our medico-legal claims are cerebral palsy-related. This is because the labour went on for too long, slow response of ambulances, or nurses delivering babies without proper qualifications,” she says.

Cowley emphasises the need to employ people who are fit for purpose. “Several top management positions are allegedly filled by shop stewards who are not qualified to be in those posts. Imagine a hospital that deals with pregnant mums, neonatal and mental units run by an unqualified CEO. [W]e can’t use political patronage to fill posts in a critical service like health; it is not acceptable,” she says.

Trollip says the only way to reduce medico-legal costs is to ensure medical health services are properly provided by competent professional doctors and healthcare workers. “The replacement of chief medical officers or superintendents in charge of hospitals, who were medically trained, and replaced with hospital CEOs (ANC cadres), has also resulted in a deterioration of care and services. We believe that if you do the job right the first time, you obviate these excessive claims,” he says.

Poor recruitment practices

More broadly, ActionSA says what’s needed beyond 29 May to deliver health services to those most in need is better recruitment practices.

Trollip argues that recruiting qualified doctors and health workers for rural areas requires a holistic approach. “Rural service incentives such as remuneration, especially for scarce skills, housing and education, should be provided. In the absence of these, rural areas will continue to suffer shortages and be underserved, with local hospitals becoming glorified clinics that simply refer patients for care,” he says.

The DA wants to get rid of “non-critical” programmes in the health department. For instance, Cowley says infrastructure for health facilities should be managed by the public works department.

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“The infrastructure programmes are notoriously riddled with corruption and overruns with no consequences,” she says. “Imagine if we could ring-fence funds from non-critical programmes such as health infrastructure or health education. If these funds can be used to settle the accruals and goods and services, which include the supply of medicines and life-saving medical and surgical equipment, you will see a dramatic improvement in service delivery.”

Beyond the 29 May polls, Madikizela says there is a “need for new leadership with the necessary skills and ideas, [and] a proper MEC with a basic knowledge of health”.

Madikizela also proposes that a task team be established urgently to mobilise the capabilities of all key stakeholders to address the health crisis in the Eastern Cape. DM

This article was published by Spotlight – health journalism in the public interest. Sign up to the Spotlight newsletter.