R1.8bn of R28bn. Six percent. That’s what would be left for service delivery in the Eastern Cape health department’s budget for 2023 after deductions for salaries, and provision for wage increases and cost overruns from the previous year, among other items. At least, that’s what former health MEC Nomakhosazana Meth told the National Council of Provinces (NCOP) appropriations committee in September, according to the Parliamentary Monitoring Group.
It’s something the Eastern Cape can ill afford. As the provincial health department’s annual report makes clear, the social determinants of health (poverty, unemployment, education, housing and access to piped water and sanitation) contribute to a high burden of disease in the province. The report points to the fact that 72% of the population lives in poverty and just 84% has access to piped water. Unemployment on the expanded definition is nudging an eye-watering 50%, according to Stats SA. Within this malaise, 89% of the people of the Eastern Cape depend on the government for health services. So it’s vital that the health-care system works.
Only, it doesn’t.
Just this month, news outlets reported astounding outages at busy tertiary facilities such as Livingstone Hospital in Nelson Mandela Bay. Some hospitals and clinics are reportedly short of needles, nappies, nebuliser masks, adult oxygen masks, oxygen regulators, special plasters, gloves, sutures, ECG electrodes, ECG paper. High-consumption hospitals are “borrowing” needles from rural hospitals, according to Daily Maverick.
In addition, the Daily Dispatch reports shortages of linen and beds, and issues with food supply. Of the province’s 432 ambulances, 196 are in for repairs. And a driver says just three are available for the 52 villages served by Victoria Hospital in Alice.
Patients of Holy Cross Hospital in Flagstaff are sent to a facility 40km away when oxygen is unavailable, and hospitals run short of heart medication and sanitiser, the Daily Dispatch reports. Hospital patients in Jamestown were told to provide their own food (they were apparently served after a reporter put in a request for comment), and patients in Stutterheim were sent more than 100km to Frontier Hospital in Komani for X-rays. At that hospital, staff and patients last month complained about a lack of water, food, medication and linen, according to News24. (The health department denied the claim.) And at Frere Hospital it was reported earlier this month that pregnant women were sleeping on the floor — and there’s a shortage of midwives.
Of the province’s 432 ambulances, 196 are in for repairs
That’s over and above the systemic issues. In the department’s 2022/2023 annual report, for example, it points out that only 56% of district specialist positions were filled; in Joe Gqabi district, there was not a single primary health-care nurse, family practitioner, paediatrician, paediatric nurse or obstetrician/gynaecologist.
In terms of leadership, the department is on its fourth head of department since 2019, and its 11th MEC in 20 years (only two have served out their terms, news service Spotlight reports).
The department’s response to the most recent outages is bordering on Orwellian doublespeak.
Speaking to the PE Express and News24, department officials denied the shortages. Though resources are under pressure, spokesperson Mkhululi Ndamase said, there is no shortage of critical supplies at Livingstone. Deputy director-general Mtandeki Xamlashe said the facility was “managing well” and another spokesperson said the medical depot was stocked. Yet three days earlier, new MEC Ntandokazi Capa’s spokesperson Sizwe Kupelo acknowledged the shortage of supplies to Daily Maverick, saying: “This is a provincial challenge which relates in part to suppliers not able to fulfil our order on time and some import challenges as some of these items are imported by contracted suppliers into the country.”
It is an administrative issue, he stressed, not the result of suppliers not being paid.
Only, that’s a perennial problem too. The department went into the current financial year R4.8bn short because of cash it owed to service providers for the previous financial year. That’s a large chunk of change — 15% of the department’s R30bn-odd 2023/2024 budget, Daily Maverick’s Estelle Ellis points out.
While the department waited for the new financial year to kick in and the money to flow, suppliers went unpaid and so stopped providing services. As Ellis reports, Telkom cut the department’s lines due to nonpayment of its R36.5m bill, and the authorities had to rely on Vodacom’s “push-to-speak” system — the equivalent of a two-way radio system using mobile networks.
In its annual report the department flags the crises caused by delayed payments: electricity outages, closure of accounts by drug companies “causing backlogs and running out of certain line items”, and withdrawal of security from facilities.
Then there are the astronomical medicolegal bills eating the department’s budget. In 2023/2024 the department paid out R339m in claims; it’s reportedly paid out a monstrous R3.7bn since 2015. The auditor-general, in a report to the NCOP appropriations committee, put the value of claims against the department at upwards of R30bn.
This is what public health can look like when not done right: a cesspit of maladministration, mismanagement and a lack of consequence management, as Daily Maverick quotes Jane Cowley, a DA member of the provincial legislature, as saying.
Former national health minister Joe Phaahla promised to assist the ailing department in September, but as Ellis notes, nothing has changed. Which goes to show just how much political will there is to fix the department.
It also points to the wrongheadedness of National Health Insurance — an obstinate focus on a system that in its current guise will be unworkable not least without issues being resolved at the most basic level of service delivery. The Eastern Cape isn’t providing much hope on this count ...
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