A health sector security contract worth R380m is at the centre of a trial in the Kimberley high court, where three men stand accused of defrauding the provincial government.
According to the National Prosecuting Authority (NPA), former provincial health department head Steven Jonkers and Defensor Electronic Security Systems directors Gert van Rooyen and Claudius Peterson allegedly flouted the rules of the Public Finance Management Act in the tender process. In addition, the NPA said Defensor wasn’t registered with the Private Security Industry Regulatory Authority, as required under tender regulations.
The defendants have denied the charges, but earlier this month the court quashed their request to be discharged from trial after Defensor’s bid documents were allowed into evidence.
The value of the contract is no small matter. For the 2023/2024 fiscal year, the Northern Cape health department’s budget is R6.1bn. So R380m amounts to 6.2% of the funds allocated to treat ill people — and it’s just shy of 90% of the R425m budgeted for emergency medical services in the province.
It’s not as if the provincial health department is rolling in cash to begin with; more than a third of its budget is already swallowed by medical negligence claims.
“The medicolegal contingent liability amounts to R2.1bn comprising 93 active cases,” health MEC Maruping Lekwene told the provincial legislature during his June budget vote speech. “Most of these cases are birth injuries which result in cerebral palsy.”
Not helping, at least in part, would have been the province’s handling of medicolegal cases in the first place. Elphas Ndhlovu, a legal adviser in the health department’s specialised medicolegal claims unit, was, in 2021, alleged to have assisted a law firm with its claims against the department.
When asked to appear at a disciplinary hearing by the department, Ndhlovu brought an application for an interdict and declarator against the department and the disciplinary hearing chair. In June the court ruled against both.
In just one case of alleged corruption, a security contract may have cost the province almost 90% of its emergency services budget
— What it means:
Then there are the nine top department officials who were arrested and arraigned last month in relation to alleged personal protective equipment (PPE) fraud involving R16m.
In that matter the NPA’s Asset Forfeiture Unit obtained a preservation order against health department head Dion Theys, CFO Mosimanegape Gaborone, supply change management director Montgomery Faas, deputy finance director Victor Nyokong and five others.
In the case of co-accused Kenyaditswe Visser, director of MKV Investment — the company that provided the PPE — the NPA seized a R4.4m Kimberley house and a 2015 Bentley Continental.
The accused have all denied the charges, and Visser is opposing the preservation order, says NPA regional spokesperson Mojalefa Senokoatsane.
Almost unbelievably, Lekwene’s office says Theys was transferred this month to the position of medical director in the health department (Alastair Kantani was appointed acting department head to replace him). And Gaborone was moved to the provincial department of transport, safety & liaison as CFO.
According to the MEC, the move was made “to strike a balance between the protection of the image of the department, the rights of employees accused on charges relating to fraud and corruption of PPE procurement, all competing public interest, as well as any internal investigation that must unfold”.
But the corruption allegations don’t end there.
In May, former provincial public works head Patience Mokhali, Tshegolekae Motaung, owner of Babareki Consulting Engineers, and disgraced former finance MEC John Block appeared in court on charges of fraud, corruption and money-laundering related to the construction of the Kimberley psychiatric hospital, worth R51m.
The development has been mired in controversy, with local media reporting some buildings had to be demolished and rebuilt due to poor workmanship.
The 2003 contract for the hospital was granted by the department that was at the time headed by Block, who is now serving a 15-year sentence for various property-related frauds in the province a decade and more ago.
We sometimes wait a whole morning in a queue to get our medicines, just to hear it didn’t arrive
Amid all this, public health services are suffering in the province.
A woman from the Kai !Garib local municipality, who asked to remain anonymous for fear of intimidation, tells the FM she goes to collect her chronic medication at the local clinic every month. “We sometimes wait a whole morning in a queue to get our medicines, just to hear it didn’t arrive,” she says. “And, you know, it’s hot here in the summer.”
Another woman in the municipality, also speaking on condition of anonymity, tells the FM she had arrived at the clinic to fetch her chronic medication to find “there is no nurse and only two [trainee] staff nurses — one of which is new and cannot work alone yet”.
A retired nurse, who worked at a clinic in the Karoo Hoogland local municipality, says: “It’s frustrating to get [to work] and see no supplies have arrived.”
It is no wonder then that, by the health department’s own admission, only 23 (14%) of clinics in the province were ready for National Health Insurance accreditation in 2021/2022 — down from 35% the previous year. That’s according to its annual report.
The main reasons, says the report, include “dilapidated infrastructure” and the “noncalibration of essential equipment”. It’s a figure that seems out of kilter with the 80.8% “patient experience of care satisfaction rate” noted in the report.
When looking at district hospitals, a worrying trend emerged in 2021/2022. Maternal deaths in these hospitals jumped to 107 out of 100,000, against 74.9 the previous year, according to the department. (The national average is 109, according to the national health department.)
Reasons for the uptick include a “lack of basic essential equipment”, including blood pressure apparatuses and haemoglobin machines, late referral to the two regional and tertiary hospitals in Upington and Kimberley and inadequate emergency medical services.
It means that a critically ill patient faces a challenge just getting an ambulance to reach hospital in a province that spans 1,000km from Alexander Bay to Kimberley, or 660km from Sutherland to Kimberley. Then, when the patient arrives at the hospital, it’s uncertain that all the necessary medical equipment will be in working order.
Even immunisation rates in the province are in decline. The percentage of children under one who were vaccinated in 2021/2022 was 72.2%, against 79.9% the previous year and a target of 88%, according to the department’s annual report. The World Health Organisation puts the national rate at 85%-91%.
Outside of “soft” reasons, such as data-capturing challenges and the non-implementation of the “Every day is immunisation day” campaign, the department flags a “shortage of consumables and lack of transport to deliver vaccines and to conduct support visits”.
Due to the remoteness of many rural communities, mobile clinics were for many years a first line of defence, immunising children and delivering chronic medicine to those in outlying areas. Now, says the retired nurse, “the mobile clinics don’t run as often as they did”.
Given what at least on the surface appears to be squandered funds, it is no wonder that the department received a qualified audit opinion — again — in 2021/2022.
For one, the auditor-general “was unable to obtain sufficient appropriate audit evidence for basic salary included under compensation of employees”. In other words, the department apparently couldn’t provide the requisite information on its own payroll. Also, it didn’t know the precise extent of its contingent liabilities, which include medicolegal claims. (The R2.1bn Lekwene referred to was not an audited figure.)
The department also did not provide proof related to the R315m it owed creditors, suggesting it could pay creditors without proof of service delivery, nor could it prove the R1.36bn in movable tangible assets, the audit report said.
Given how its finances are run, negative perceptions of the provincial health department seem inevitable. “These people don’t care,” says the woman who often queues in vain for her chronic medication at the Kai !Garib clinic.
The provincial department of health had not responded to the FM’s questions at the time of going to print.
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