SAFTU notes the spike in the number of horror stories emanating from public hospitals in South Africa. The cases range from babies losing their lives at birth, babies becoming physically and mentally impaired for life as a result of negligence, mothers losing their lives at birth, others losing their wombs after birth, the mass murder known as Life Esidimeni, unhygienic hospital wards, rotten food served patients, surgeries going wrong, the lack of strong painkillers, and many more.
Malpractice lawsuits that result are so expensive that in one province alone, Gauteng (hosting some of the country’s best public health institutions), the Health Department’s latest annual report admits its potential medical-legal claims are now R21.2 billion, an increase of R1.9 billion from 2019. The annual payments made mainly for brain damage during childbirth are in the R300 million range. At a time the Treasury is cutting harshly into the marrow not just bone of the health system, this lack of quality control signals both a fiscal and treatment death spiral.
The country was shocked last month by the story of a child admitted at Bernice Samuels Hospital in Delmas for diarrhoea, who ended up with an amputated arm. The official story was that she was put a drip that led to her arm turning green, either due to the fluid in the drip or the way the drip was inserted, leading to severe damage to the hand resulting in its amputation.
Less than three weeks later, other horror cases had emerged about the same hospital. Families reported of their family members who went missing after dying at the hospital. Mkhumbeni Mandisa had a cut bladder after a misdiagnosis and incorrect surgical procedure. Now she cannot hold her urine and must wear diapers. Mbali Jiyane, 24 years old, lost her womb. Doctors left a placenta inside her stomach after helping her to give birth through ceasar. The toxic placenta damaged her womb, leading to its removal.
These revelations come at a time the story of gross neglect that led to Shonisani Lethole’s death still rings fresh, and the horrors of Life Esidimeni that saw 144 dead and 8 missing the same year as major national-to-provincial budget cuts.
The British state broadcaster BBC revealed last year that nurses often become cleaners, and showed picture of rats feeding on the blood waste in one hospital. More and more people are losing their lives, whilst others become physically and mentally impaired. Health-E News reported in 2016 that there were 43 deaths per 1000 babies in the Eastern Cape, and 254 maternal deaths per 100 000 births in the Northern Cape – both unacceptably high, reminiscent of the apartheid era.
The horror stories behind these cold figures paint a grim reality and are indicative of the crisis that engulfs the public health system. People have lost confidence in public health. Public hospitals have become symbols of death or other distressing consequences. In many areas, the elderly despises hospitals and would refuse to go hospitals no matter their illnesses because they liken them to mortuaries. In the first decade of this millennia, it would seem the proliferation of the horrors in hospitals were farfetched, but this has become an accepted reality.
It is true that some of the neglect that leads to fatalities, impairments and other such traumas are due to neglect of the responsible staff, individually or collectively. The scolding of patients, disrespect and other attitudes representing the opposite of batho pele principles are far too common, and experienced by poor and working-class people who most desperately need public health services.
However, a broader systemic failure lies at the heart of these problems based on three main factors: inadequate funding, understaffing, chronic shortages of infrastructure and incompetent management.
The obsession with deficit stabilisation and fiscal discipline by Treasury is set to cut the health budget by over R50 billion in the next three financial years, in spite of the ongoing pandemic. The budget increase from 2009 to 2012 was followed by a plateau at 1.52% from 2013 until 2019, far below the healthcare inflation rate.
The poor funding of the public sector has prevented not only adequate clinic operations but also to inadequate hospital services, in spite of the vast population that depends on public health. Covid-19 exposed the lack of infrastructure in the public health sector which caused incapacity in terms of admissions in various hospitals. In some hospitals, wards were filled to capacity and other had to be put on corridors.
Closely related to the issue of infrastructure; is procurement of equipment in hospitals. Some hospitals even lack pain killers for trauma wards and patients have been reported wandering in the ward corridors during the night because of unbearable pain. There was a severe shortage of equipment last year, including even N95 masks and Personal Protective Equipment related to Covid-19. Staff in various hospitals embarked on protest action in demand for Covid-19 PPEs last year. One reason was tenderpreneurship corruption, reaching up to the Presidency where the spokesperson was compelled to take leave.
Further, lack of funding led the Health Department to freeze the filling of vacant posts. In 2018, there were 37 000 public health sector posts that were unfilled, and even more are apparent in 2021 due to Treasury austerity. These vacant posts include auxiliary staff, cleaners, security, nursing sisters, doctors, and specialists. Hospitals are under severe shortage of nurses despite many young, qualified nurses graduating with nursing diplomas in the specialised nursing colleges across the country. In many clinics, managers constantly use Community Healthcare Workers (CHW) to augment their staff, for work that the CHW are not qualified and allowed to do. And yet the option of insourcing the CHWs is still too rare, limited to Gauteng after a major struggle during 2020, in spite of so many risking their lives during Covid-19.
The case of nurses having to clean after themselves in hospital wards is due to the fact that cleaning staffs are severely understaffed. Hence hospitals are now places of filth and spreading of disease, instead of good hygiene and recovery. Rotten food is suggestive of dysfunctional storage due to refrigerators failing and understaffing of the kitchen staff.
In addition to budget cuts, there are incompetent managers appointed through ruling-party cadre deployment, as is often recognised even by political leaders. The bad managers spend their hospital budgets irregularly. They often fail to establish an effective worker environment that can ensure staff maintain the highest levels of ethical conduct.
Irregular expenditure within a constrained budget compounds the problem. Failure to inculcate ethical discipline in clinics and hospitals makes them undesirable, due to long queues and the attitude of disrespecting patients evident in many managerial and frontline staff.
The two-tier health system contributes to this. Enticed by better benefits, the country’s leading doctors, specialists, and nurses move to the private health sector.
The answer to this unpleasant reality is the National Health Insurance. NHI is the model and mechanism which could ensure adequate health care services to all persons in this country, regardless of their income or nationality. Government must radically improve the budget on healthcare, and reconstruct the health system. The last period we have suffered, of government pretending to care about NHI but Treasury giving it only tokenistic funding, must now finally end. If we are to recover from the Covid-19 pandemic, instead of manifesting yet more healthcare apartheid, a much different allocation of resources is required, one that no longer panders to austerity, corruption, mismanagement and profiteering.