On Wednesday, Minister of Health Aaron Motsoaledi appeared before the Parliamentary Portfolio Committee on Health to respond to the South African Human Rights Commission’s damning investigation into the treatment of cancer patients in KwaZulu-Natal (KZN).
He identified weaknesses in the processes of provincial human resources and anomalies peculiar to KZN in its procurement supply chain system as the underlying causes.
Posts are not filled as fast as they are vacated. The effect is that the pressure created by staff shortages drives newly qualified staff to other departments of health or into the private sector. He also identified the “disinclination by senior management in the province to delegate recruitment functions”.
He said the Department had been made aware of the problem a month before the situation was brought to the attention of the public in June by the SAHRC.
In May 2017 the Minister dispatched a team from his department, led by the Director-General, to visit the province to investigate the problem. This was in response to a march on 5 May by doctors belonging to the KZN Coastal Branch of the South African Medical Association (SAMA) who had protested to highlight the conditions under which they were working in the province. They handed over a memorandum to the KZN authorities which was forwarded to the Department’s Director General.
As a result, Motsoaledi said a meeting is due to be held on 8 September where the MEC for Finance will report on the results of an investigation that she instituted into the contract to maintain the oncology machines at Addington Hospital.
The Minister also expected a list of minimum critical posts to be compiled, costed and handed over on that day to the MEC for Finance and the Premier for consideration. The Director General of the national department is expected to be present for the presentation.
Motsoaledi’s report listed urgent interventions. Topping the list was efforts to fill vacant posts, not only oncology specialists but other specialists and leading personnel needed to deliver effective health services in the province.
He also said a Health Technology Unit which was responsible for processing all KZN Department of Health purchases did not have the “required capacity leading to very long turnaround times for equipment purchases and maintenance”.
He said that the Unit had “not demonstrated the necessary capacity to run this function effectively [and] should not be allowed to purchase equipment on behalf of institutions”. Motsoaledi proposed a deviation to allow the National Department of Health to procure equipment on behalf of the provincial authorities.
“The practices of HR and procurement and supply chain management will have to be disrupted in more ways than one and this will need cooperation of the whole government, specifically the Premier’s office and the Treasury,” Motsoaledi concluded.
He said he had asked the KZN Premier to call an urgent meeting with the MEC for Finance, the MEC for Health, their senior support teams, the Deputy Vice-Chancellor of the University of KZN, the Dean of the Medical School and his five heads of department. This took place on 18 August and was followed by a week-long visit at the end of August by senior members of the National Department of Health.
Meanwhile, the SAHRC had conducted interviews with staff and patients in KZN, held in loco visits, and released a report on 15 June confirming that there were insufficient radiotherapy devices in the province. It reported both radiotherapy machines at Addington Hospital were not working. Patients had to wait for about five months to see an oncologist and an estimated eight months before they were able to start radiation treatment.
Addington was referring patients to the Inkosi Albert Luthuli Central Hospital, where equipment was working, and a plan to get private oncology specialists to provide pro bono treatment to attempt to stem the growing waiting list had been negotiated.
The SAHRC had concluded in its report that the KZN Department of Health was failing to provide oncology patients with adequate health care services and that this amounted to a breach of their constitutional rights to health care and dignity.
The problems identified by the SAHRC were similar to those identified by the Department, as were its solutions.
The Department of Health had been alerted to the looming crisis as early as April when it emerged during the course of a discussion on breast and cervical cancer policies. This resulted in a resolution to conduct an audit of oncology equipment in all provinces.
At this week’s committee meeting in Parliament, the Minister was at pains to point out that some provinces did not have any sophisticated cancer detection and treatment equipment. Patients from Mpumalanga and Limpopo, for example, had to seek treatment in large centres in Gauteng. The North West shared its resources with the vast Northern Cape province.
It was unclear whether the Minister was using evidence of equal or worse healthcare provision in other provinces to justify the inadequate medical services in KZN that had made headlines.
What was clear was that the Minister felt that as a concurrent responsibility, healthcare fell under provincial responsibility, at least when it came down to the two areas of dispute, namely human resources and procurement. Motsoaledi made it clear that this applied to healthcare across the board, and not only oncology services.
The Minister has shaken up the supply chain management procedures to remove much of the red tape that obstructed purchases of goods and services. However, an ongoing dispute with the service provider contracted to maintain the equipment is now bogged down in a court case, although there has been some progress, with one of the radiotherapy machines at Addington now being repaired while the other is to be procured by the national Department of Health.
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