Defend Truth


The Eastern Cape health system has collapsed — and the poor and working class are paying with their lives.


Thembisa Joy Witbooi is an activist who was previously employed by SA Revenue Service and is currently employed by Nehawu as a regional organiser. Views and opinions in this article are her own.

'That’s the standard technique of privatisation: defund, make sure things don’t work, people get angry, you hand it over to private capital.' Noam Chomsky

Poor and working class people are sitting in a desperate position, facing the ongoing energy crisis and rising cost of living, with more than 12 million workers already unemployed. 

Consequently, the social fabric is rapidly declining. Collectively, these social and economic ills also negatively impact South Africa’s food security by making basic nutrition a luxury most people cannot afford. Food becomes too expensive and largely inaccessible, which increases the number of households experiencing hunger. To illustrate, in 2021, Stats SA reported that more than half a million (683,221) households with children aged five years or younger experienced hunger.

In Gqeberha, media reported that more than 108 children were hospitalised with acute malnutrition, while 10 died, in 2022. These deplorable findings demonstrate who suffers most when poverty strikes, and who benefits when public services such as schools and hospitals, are adequately funded. Women and children bear the brunt of the costs when basic services fail. 

Therefore, we must fight for public services to work because it is us, the working class and poor, who are affected and suffer the most when public services become dysfunctional.

This is why my heart aches about the public health system in the Eastern Cape province. 

Such an abnormal state has been accepted by almost everyone as the norm, while it is the poor and working class who face their collective suffering alone. Imagine waiting for an ambulance that arrives hours later simply because such services are understaffed. We are in a state where those responsible for this deterioration in the public service sector, the lawbreakers and transgressors, are celebrated and rewarded with more authority, while abandoning the communities of the working class who depend on them.

In September, the MEC of Health in the Eastern Cape announced the redeployment of the head of department (HOD) of the Department of Health. It was said that this decision was taken to strengthen the administration of their department. 

Read more in Daily Maverick: Premier Mabuyane under fire for moving E Cape head of health 

What is there to strengthen when almost the whole administration of this department is rotten with corruption, neglect and malfeasance? I do not believe that HOD Dr Rolene Wagner had any real chance to change this department since the people sitting in their Bisho offices are there to ensure that anyone and everyone who is appointed in this department fails. 

My observation is that the incompetence of this department is deliberate, culminating in what has become a conveyor belt of corruption. 

Here I’ve tried to put some meat on this bone:

  • In May 2022 it was announced that there are more than about 3,500 ghost employees in this department. To date, no report was ever released in relation to this issue. It was reported at the time that there was a doctor in forensics who had retired two years back, however, the person was found to still be receiving a monthly salary totalling more than R700K. If a forensic audit could be launched, then there are billions of rands to be recovered.
  • In March 2023, this department’s medico-legal claims totalled up to R40-b An amount almost 50% of the departmental budget allocation. The major cause of these legal proceedings are dire shortages of staff in health institutions. Common sense would tell us that to reduce this litigation, the department should appoint more qualified health workers.
  • While other provinces are making efforts to absorb Community Healthcare Workers (CHW), in this province there’s no effort whatsoever. People are continuously being exploited on a daily basis. Some CHWs have been on the system since before 1994, working all the while, and receiving less than R5,000 a month without any benefits. When they leave the system through retirement or death, all they receive is a thank-you letter. The department always complains that it has no money to employ, however no control measures are in place to curb the huge amounts of money lost through corruption and self-created negligence. On 12 June 2023, the National Assembly passed the National Health Insurance (NHI) Bill, and the role of CHWs is critical for the NHI to be effective in our communities. In the absence of a plan to absorb CHWs in this province, the implementation of the bill itself will be impossible.
  • Some people have been on continuous internships in this department for more than eight years without getting permanent employment. The only change the department makes is to transfer the institution where the internship is offered. What is the meaning of an internship? “An internship is a professional learning experience that offers meaningful, practical work related to a student’s field of study or career interest. An internship gives a student the opportunity for career exploration and development, and to learn new skills.” In principle, the department of health provides internships for early career development, while in practice an internship in this department is offered as a form of exploitation.
  • There is so much instability in management; many managers are in acting positions, and this equates to lack of accountability. To mention a few: Livingstone Tertiary Hospital; Jose Pearson TB Hospital, Humansdorp Hospital.
  • The PE Medical Depot is operating on more than 70% contract staff, and less than 30% employees are permanently employed. How can an institution fully operate on contract workers? These contracts are also issued to exploit our people instead of offering permanent employment. This is where most placements of internships are found.
  • The population of Sarah Baartman District Municipality is 527,062 people. With an annual population growth rate of 1.14%, the population is estimated to increase to 564,000 people by 2025. Currently this district has 56 ambulances, of which 31 are down; that therefore means 25 are in operation. The government aims for a ratio of one ambulance per 10,000 people, on average. This means the ambulances in operation are not even 50% of the targeted ratio within that particular district.

Read more in Daily Maverick: Children are dying of hunger in the Eastern Cape – declare a disaster, urges Human Rights Commission

The negligence, corruption, unaccountability and collapse in the Eastern Cape Department of Health is indeed directly affecting service delivery meant for our communities.

  • The dire shortage of staff is the reason why our communities have to wake up in the early hours to stand in queues when they visit health centres. Sometimes they have to stay almost the whole day before they can receive service.
  • This is the reason why our communities have to wait for more than five hours for an ambulance.
  • The reason why this department cannot employ and absorb CHWs is because the bulk of its budget is channelled through medico-legal claims, and of course, the unaccounted ghost employees.

In terms of the Batho Pele principles, all citizens should have equal access to services, which is enshrined in our constitution. Section 27 of the Constitution provides that “everyone has the right to have access to health care services, including reproductive health care, and no one may be refused emergency medical treatment”. The state of medical care in this province is in violation of the Constitution itself.

The only solution, in my opinion, to fix all irregularities that exist in this department is for the national office to take a critical and needed decision to put this department under administration until it finds its feet.

We need to fight to repair the public service sector as it is the poor and the working class who will suffer the most should it fail. DM


Comments - Please in order to comment.

  • Fanie Rajesh Ngabiso says:

    The situation is a tragedy, and is echoed in many ways throughout South Africa.

    There is only 1 way to improve and I do hope all our people wake up to it before our country implodes completely.

    Vote DA.

  • Corry Versluis says:

    Do not forget the role of the unions. They run the department. Errant staff are protected and disciplinary cases deliberately sabotaged. The Medical depot for example, the permanent staff there simply refuse to work, or do go slows. Any attempt at corrective action and the unions jump in, threaten and intimidate. There is simply no consequence for arriving late, extended tea and lunch then leaving early. Absenteeism om Mondays, Fridays and around pay day is huge. Employees claim family responsibility leave for anything, abuse sick leave and when the 36 days if a 3 year cycle are used up, simply get granted special leave.
    The few of us that try and work are the butt of jokes and ridicule and micromanaged by managers too scared to take action but want to look like they do something. It really is a massive shitshow

    • Fanie Rajesh Ngabiso says:

      Your comment is terrifyingly sad and terrifyingly believable. Your position sounds horrible. I wish I had the power to help you but unfortunately there is just no solution I can think of to preventing self destruction when people actively seek it.

      • Corry Versluis says:

        Don’t get me wrong, I love my job. Like the story of the girl throwing the starfish back into the sea, I focus on helping the person I can. There are many good people who each do their most, and somehow, the wheel keeps turning. But yeah, it’s tough.

  • Ben Harper says:

    Well you get what you vote for. And as a union organiser and that union being part of Cosaty, you are very much to blame for the sad state SA is in now. You’ve stolen, pilfered, destroyed and pillaged for decades now and somehow you’re surprised it’s all falling down?

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