The Gauteng Department of Health annually spends millions on security at its health facilities based on contracts that expired in 2016 and that since have been extended from month to month. Yet, theft, vandalism, and reports of healthcare workers held at gunpoint and who work in fear continue. Despite this, the department insists that spending on security is not wasteful and "the business case for security remains robust".
Security at Gauteng health facilities came under the spotlight in recent months, sparked by the multi-million rand theft of copper cables (worth R30 million) and equipment (to the value of R200 000) at Charlotte Maxeke Hospital. Figures provided by the Gauteng Department of Health show that from the 2017/18 financial year, the department paid close to R150 million to Mabotwane Security Services for security at this hospital. This prompted DA member of the Gauteng Legislature Jack Bloom to question if this was value for money.
In answer to a question raised earlier in the National Assembly in Parliament on this and if the security company will be held liable, the then Health Minister, Dr Zweli Mkhize said the hospital has a service level agreement with the security company which guides the parties on issues such as penalties for violations.
"It has been difficult to apportion the liability to the security company as all hospital staff had to vacate the building due to the uncertainty on the safety of the building, including security personnel," he said. "During the temporary closure of the hospital, the (provincial) Department of Infrastructure Development (DID) took advantage of the situation and invited contractors to do fire remedial work and some maintenance work in the wards. This meant that the hospital had several contractors on site."
According to the former minister, "most of the hospital walkways are covered by camera surveillance except for the fire escape routes" so as a result, "it was not possible to review that footage in the areas where equipment was stolen". The provincial health department pays almost half a million rand (R450 000) a month for repairs and maintenance of CCTV equipment.
It is not only at Charlotte Maxeke that such incidents have been reported, but at various hospitals and clinics across the province.
Gauteng secretary of Denosa Bongani Mazibuko tells Spotlight healthcare workers are concerned about these incidents which have an impact on their safety and ability to deliver healthcare services.
He says when employees are not feeling safe, they are likely to end up making mistakes in their line of work which can be serious considering that they are dealing with people's lives. "When the thugs go and raid the institutions for whatever they are trying to acquire nobody knows if they are on drugs or what is their state of mind, meaning that they could post a potential threat to the employees."
Mazibuko says to improve safety in facilities, there are a few things that they have already agreed on with the department. This includes ensuring that all health facilities have a secure fence and have adequate lighting in the evening especially near the parking areas.
Sibongiseni Delihlazo, Denosa's national spokesperson says that many healthcare facilities throughout the country, especially clinics, have become easy targets for criminals. According to him both patients and nurses are extremely vulnerable. "Some have been hurt inside the facilities and criminals have gotten away with their belongings such as cell phones, money, wallets, watches, and even their cars get stolen during the day."
Delihlazo says that criminals have noticed the neglect of security and that weekends are especially tough for health workers. "It often happens that many taverns in communities are closer to the clinics. Once drunk, some community members would just come into facilities to cause havoc and sometimes injure nurses.
He says Denosa has long called for the insourcing of security personnel by the government but that this plea has fallen on deaf ears.
Held at gunpoint
One nurse who is a member of Denosa who works in Tshwane says last year she was held up at gunpoint at the clinic.
"I had an argument with a female patient. She called her husband to come and deal with me and when he arrived, he assaulted me and pointed a gun at me," she tells Spotlight. She says she opened a case at the nearest police station.
In another incident, a professional nurse resigned because of safety concerns.
"The clinics are not safe compared to hospitals, she says, often because there are fewer security measures.
"In 2018, I used to rotate between the clinics in the Gauteng North region. At most of these clinics, there was only one security guard and in most cases, it was a woman," she says. "At our clinic, we only had one security guard during the day who was a woman and a male guard for the night shift."
She tells Spotlight she was assaulted by a patient but had to undergo a disciplinary hearing who found that she was "the one who was wrong". "When this patient assaulted me I was pregnant but she quickly went to the police station to open a case of assault against me and a week later I was arrested."
'Easy to rob'
When Spotlight spoke to a security guard at one of the facilities (who asked to remain anonymous), he said that "it's so easy for the facilities to be robbed even while there is security on duty".
"We guard the hospital without firearms because carrying a gun in the hospital setting where there are patients, including kids, is an offence according to our employers." He says when thieves get into hospitals, the security must call for backup armed response that must come and rescue them. "In some cases, we don't get time to call for an armed response as everything happens so fast and thieves even take those phones from us," he says.
"We work 12 hours a day from 6 am to 6 pm, then night shifts from 6 pm to 6 am. Our job is to search cars as they come in and out of the facilities. We also have a list of patients who have appointments with doctors and we monitor the CCTV if the facility has one," he says.
Spotlight requested comment from the Private Security Industry Regulatory Authority (PSIRA). They referred all queries to the relevant security companies, which all declined to comment.
What does it cost?
Figures provided by the Gauteng Health Department show that for just seven of the bigger tertiary hospitals in Gauteng (including Charlotte Maxeke) the department spent just over half a billion rand (R503,8 million) on security in the 2017/18 financial year.
This week, figures that Gauteng's MEC for Health Dr Nomathemba Mokgethi provided in answer to a question on security contracts at Gauteng hospitals posed by Bloom in the provincial legislature, showed that the department paid a total of 59 security companies over R2.6 billion since the 2017/18 financial year.
According to spokesperson for the Gauteng Department of Health, Kwara Kekana, the security contracts cover general security, deployment, and monitoring CCTVs, among others. Kekana says that these contracts are not standardised as each facility's security needs and risks are different. "Every facility pays security services from its budget for Goods and Services or its Operational budget."
Responding to Spotlight's request for a comprehensive list of security incidents at health facilities in the province, Kekana could not provide these details. She says facilities and districts each have registers to record incidents relating to security and such information is then submitted to the Head Office. "The central office will then make follow-ups with law enforcement agencies where necessary to ensure that cases are followed up until they are finalised," she tells Spotlight. "After an incident, the facility must report the matter to the district office and to the central office, so that a preliminary investigation can be instituted if not sorted at that level." She says the department does follow-ups with the facility and where the need arises they do site visits.
Questions over contract management
Mokgethi confirmed these security contracts, originally awarded in 2014, were meant to expire in September 2016 and had since been extended on a month-to-month basis costing in excess of R2 billion. The original contracts were awarded only for a two-year period.
According to a new report on Procurement Risks Trends (yet to be published), Corruption Watch explains that in Section 217(1) of the Constitution it is stated that procurement must comply with five principles when organs of the state procure goods and services. This includes procuring goods and services based on a system that is fair, equitable, transparent, competitive, and cost-effective. Until the draft Public Procurement Bill is adopted, there is no single piece of legislation that governs procurement in all institutions of the state. The Public Finance Management Act (PFMA) governs procurement by national and provincial departments.
Kirsten Pearson, Project Specialist at Corruption Watch says the National Treasury supply chain management Instruction Note 3 of 2016/17 states that contracts should not be expanded by more than 15% of the original value. "The instruction note expressly warns that deviations in excess of the prescribed threshold will only be allowed in exceptional cases and the department must obtain prior written approval from the relevant treasury. When approval is not obtained, the Auditor-General's office regards it as being a procurement irregularity," Pearson explains.
"So, continuing to extend a contract's duration and expand its value without obtaining the necessary approval is not in line with the Constitutional principles that envision a competitive and transparent bidding process," she says.
In the 2019/20 report of the Auditor-General (AG) on audit outcomes for provincial departments, the AG highlighted that the Gauteng Health Department incurred irregular expenditure of about R2.3 billion. The biggest chunk of this was for month-to-month security contracts for health facilities.
When the Standing Committee on Public Accounts (Scopa) in the Gauteng Legislature flagged this irregular expenditure in 2019, the department then said the security contracts matter dating back to 2016, had been "concluded". The department also said it was "in the process of inviting new tenders for security as well as insourcing of security services and that no disciplinary action had been taken as employees left the department".
Pearson says this lack of consequence management is a concern that has been highlighted repeatedly by the Auditor-General reports. "Accountable officials in a range of institutions are failing to ensure that procurement follows the required legislative prescripts. Officials who have acted in a manner that gave rise to procurement irregularities rarely face consequences and persist in doing so year after year," she says. "Bad practices often result in public resources being spent in a manner that is not in the public interest. These trends will not change themselves. Procurement risks need to be addressed by public servants implementing improved preventative controls and ensuring that procurement is planned well and conducted in line with the rules that govern it."
While the Auditor-General has flagged spending on these security contracts as irregular, Kekana tells Spotlight that despite this "the expenditure is not fruitless and wasteful as the business case for security remains robust".
Kekana says the issue of how much is spent on security and if it is value for money, is "a debatable subject".
The Health MEC insists in her written answer to Bloom's question that none of these (the current 59) security contracts were awarded irregularly.
But according to Bloom, an earlier forensic audit of these contracts (dating back to then Health MECs Qedani Mahlangu and Dr Gwen Ramakgoba's terms) found that there were irregularities in awarding the contracts, and at one stage criminal charges were laid against the chair of the bid evaluation committee. Despite this, the same contracts were extended and continue to be extended on a month-to-month basis.
Bloom in an earlier press statement bemoaned the fact that the Gauteng government has spent "R63.8 million on 54 reports to investigate suspected corruption, but not a single one of these reports have been made public despite claims that the recommendations made have been implemented or are in the process of being implemented". The security tenders in the provincial health department were among these.
Meanwhile, when Bloom asked Mokgethi on what legal basis these contracts are paid month to month, she replied that "due to the critical nature of the services, there was a need for extension of contracts, therefore the service rendered needs to be paid".
Mokgethi said a new tender was advertised in September last year (2020). She attributed delays in awarding a new tender to the "high volume of responses as well as the various phases of the evaluation process". "However it is now at the final phase," she said.