7 June 2018

South Africa: 'My Hands Are Tied' - Motsoaledi


"Whenever there is a crisis, I'm called in to solve them, but I don't have the legal mechanism to prevent them," says minister.

Poorly managed emergency psychiatric wards, as well as a lack of security around newborn babies, were just some of the healthcare failings recorded by the Office of Health Standards Compliance (OHSC) in a new report released this week.

The oversight body found that, with the exception of the Eastern Cape, health facilities in most provinces had not shown significant overall improvement in the last three years when scored on categories including cleanliness, patient safety and medicine availability.

On Wednesday, the Democratic Alliance in Gauteng alleged in a statement that a psychiatric patient had jumped to his death at the Thelle Mogoerane Hospital in Vosloorus, east of Johannesburg. Just hours later, the party also said a baby had gone missing from a clinic outside Tshwane.

Health Minister Aaron Motsoaledi created the OHSC in 2013 to deal with complaints about the quality of care in the public sector. The body's latest findings come on the heels of a Tuesday press conference in which Motsoaledi admitted the country's health system was under strain but denied allegations that it had collapsed. He explained that 200 national health department officials had been deployed to hospitals to help improve management.

But until the national health department has more say in how provincial health departments function, Motsoaledi says he's largely powerless to prevent provincial health crises. He sat down with Bhekisisa editor Mia Malan to explain.

1. Are your hands tied when it comes to provincial emergencies?

Whenever there is a crisis, like with Life Esidimeni or the oncology crisis in KwaZulu-Natal, I am called in to solve them. But I don't have the legal mechanism to prevent these crises from happening, because Health MEC's don't report to me; they report to their respective Premiers.

Interventions sometimes do happen, but it happens without the full backing of the law. It happens maybe with some political gravitas, or goodwill, or humanity, or a sense of cooperation.

You can't run a country by hoping.

2. Why is corruption so rife in procurement?

In the health department, you have to buy everything: medicine, linen, food, cleaning services, laundry services. In every corner you look, there is something that needs to be bought.

I think that's what causes our problems. I won't shy away from it.

Procurement is a bone of contention, especially in the North West. I [the national health minister] only come in as a sort of a post-mortem. Under no circumstances would I have agreed on a procurement like [the R190-million illegal tender to the Gupta-linked] Mediosa to take place. But I am forced to come in when it is already too late.

3. How do politics affect service delivery?

As a minister, you have no say in who gets hired and at what level. Human resources is a purely provincial function, which is exercised by the Premier - not even by the MEC.

The health minister is an executing authority only for those people who are hired at a national level. But for all the others who are working in hospitals, that's where delivery is, executing authority is the MEC.

For example in the North West, I pleaded with the Premier not to appoint the current head of health [Thabo Lekalakala]. But he insisted, and there was no law under which I could stop him. I knew Lekalakala couldn't run a directorate.

4. What's the solution?

Our dreams of a National Health Insurance (NHI) will never happen if our provincial health systems aren't working. In the NHI white paper, we are proposing that 12 acts need to be amended. We are targeting the issues of human resources, financial management and procurement specifically.

5. What else has to change for the NHI to work?

One of the reasons there is good quality in the private sector is because the person who buys services is not the same as the one who provides them.

In the public sector, the purchaser and the provider is one person, the MEC. The MEC is given a budget by the treasury to provide health services to citizens. The MEC must go and hire nurses, make sure there is equipment, and then go purchase the services for the citizens the same services he has provided.

Whether the services are good for the citizens or not, it doesn't matter - nothing pushes you.

Under the NHI, districts will be able to send their patients to where the best service is. That set-up will create more competition and credibility, and force people to jack up [their services].

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