Why Supra Mahumapelo may hold his fate and that of his province in his hands.
Trade unions protests have brought the North West to its knees, closing health facilities and forcing hospitals to discharge even the sickest of bedridden patients. And only Premier Supra Mahumapelo's resignation will bring an end to the crisis, say union leaders.
"If the premier steps down, even now, then we can go back to the negotiation table and proceed, and advise our employees," says Motlalepule Ramafoko, acting provincial secretary for the Democratic Nursing Organisation of South Africa (Denosa).
The nursing union and the National Health Education & Allied Workers Union (Nehawu) embarked on a go-slow in the province more than a month ago that has crippled healthcare in the province. The protest action has now turned into a stay away for many nurses after violent demonstrations erupted in Mahikeng this week and Denosa says it now fears for their safety.
"The security of our employees is compromised," Ramafoko explains.
"We never made any total shut down. We were working with a skeleton staff until yesterday when the community decided to take over our strike. Now the communities are the ones striking."
Calls for Mahumapelo's ousting follow revelations that the province awarded R180-million rand in illegal tenders the Gupta-linked company Mediosa for mobile clinics. Of this, R30-million rand was paid out to the medical technology company before the vehicles were delivered.
The current situation in #SupraMahumapelo's Mahikeng: Petrol bombs being thrown at the @SAPoliceService. pic.twitter.com/HxoO9IIii5
- Bhekisisa M&G Health (@Bhekisisa_MG) April 19, 2018
As of Thursday morning, health workers at the Mafikeng Provincial Hospital were phoning families to come collect patients from the hospital wards and had been forced to discharge some patients without medication. Healthcare workers reported that cars attempting to enter or leave the facility were being stoned, forcing them to shut down the emergency room. Doctors were being warned not to report for duty, and those that had were being advised to leave for their safety. About four kilometres away, protesters had also blocked the entry to Victoria Private Hospital.
Residents in the Mahikeng's Lonely Park neighbourhood say they have been lining up daily in hopes that the local clinic will re-open after it closed its doors earlier this week.
At the time of publishing, North West health department spokesperson Tebogo Lekgethwane confirmed that the department remained in talks with the South African Health Military Services regarding their potential deployment to affected health facilities. This comes on the heels of reports by the Treatment Action Campaign and public interest law organisation Section27 that 95% of medicines in the province are out of stock, according to Vuyokazi Gonyela, Section27 national strategic plan advocacy officer.
Almost 400 clinics and hospitals are estimated to have no medicines or are running on dangerously low stock levels, medication monitoring consortium Stop Stockouts Project warns.
Violent protests erupted in Mahikeng earlier this week by which time, some clinics had already been closed for several days because of drug shortages, residents say.
Ndiviwe Mphothulo is a doctor in rural Taung, about 231 km south of Mahikeng. He says that 80% of his patients on chronic medication for illnesses such as HIV, hypertension or diabetes have been spared treatment interruptions because they collect their medication at private pharmacies as part of the national health department's Centralised Chronic Medicines Dispensing and Distribution programme. The public-private partnership allows long-term, chronic patients to collect their drugs outside of clinics to help decongest overburdened clinics.
But the programme doesn't cover mental health patients, Mphothulo warns.
"Our problem is mental health treatment. [The mental health patients] are the ones who have to go to the hospital for their treatment and spend their last money," he explains.
"Taung is a vast and largely undeveloped area. A taxi to the hospital costs R160 there and back, which is a catastrophic cost for most patients."
"[Mental health patients] have to choose between food or going to Taung hospital," Mphothulo explains.
He says that pharmacists at the district hospital have been putting in long hours trying to match each medication with its supplier and then place orders.
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The national health department has instructed suppliers to deliver medicines directly to health facilities. But it will cost the province, which already has to pay off the almost billion-rand it overspent in last year's budget. This includes an unexplained tripling of drug costs in one district, says Russell Rensburg, health systems and policy manager at the Rural Health Advocacy Project (RHAP).
"There was no medical emergency, an outbreak of malaria...There wasn't a 300% increase in communicable diseases or people that they put on treatment yet they spend three times more."
"We can't say that the medicines actually reached clinics," Rensburg says.
But what RHAP can say is that certain budget lines in the province are being underspent.
"Budgets allocated to specific line items such as human resources are often underspent and instead reallocated to provincial priorities or goods and services budgets that are used to procure services and buy medicines," Rensburg told Bhekisisa earlier this week.
"In this goods and services budget, there is greater opportunity for directing the funds to service providers such as the Gupta-linked medical technology company Mediosa."
Nehawu and Denosa are also calling for an end to outsourcing and corruption.
"Today, patients and health workers in North West will continue to scramble to access life-saving medication. The health emergency in North West provides an opportunity for bold leadership that can begin to address a legacy of failure that has arisen over the past nine years," Rensburg says.
"Failure to act can be seen as tacit approval for the ongoing plundering of the state."
- Additional reporting by Pontsho Pilane, DC Bush and Joan van Dyk
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