Health minister Dr Joe Phaahla last week announced several measures to mitigate the impact of loadshedding on healthcare services - a move that was met with mixed responses. Some have welcomed the move, while others argue it is long overdue.
At least 37 hospitals have thus far been exempted from loadshedding and work is underway to include more across provinces. According to Foster Mohale, spokesperson for the national Department of Health, the number has increased, but the updated numbers are not yet available.
"inexplicable" and "unforgivable"
Dr Aslam Dasoo, of the Progressive Health Forum, tells Spotlight that they are pleased that the minister intervened in the crisis caused by loadshedding at hospitals, but he questions why it took so long. He says it is "inexplicable that after years of loadshedding, it took only two days after the minister's intervention for City Power in Johannesburg to start exempting public hospitals from the blackout schedules".
"It was possible for hospitals in the Western Cape to be exempted four years ago through normal engagement between the municipalities and the provincial Department of health. What was the Gauteng provincial health department doing all that while?" he asks. "To have neglected something as elementary as exemption of hospitals from loadshedding, causing untold distress and death that this negligence has caused is unforgivable."
Everything's delayed
Professor Adam Mahomed, head of the Department of Internal Medicine at Charlotte Maxeke Johannesburg Academic Hospital, says the exemptions are positive moves by the health department because they will make life easier for the big hospitals.
"But this is the first aspect of it. I think we tackle the biggest emergencies and are the biggest users of diesel for the biggest generators and I'm happy with where we are. But it has to filter down to all healthcare structures. It can't just be about the big tertiary hospitals or the big hospitals, it must filter right down to all the primary health care clinics," says Mahomed.
In most hospitals, Mahomed explains, a generator is currently an option when the power goes off but a generator doesn't supply power to the entire hospital - only to areas designated as critical.
"So non-critical areas will not get power, but there will still be patients there requiring service delivery. So those patients end up getting seen inadequately in the dark. And everything is delayed, from opening up a file, getting medication, seeing a doctor, and getting procedures done," he says.
When Phaahla announced the interventions, he also said that the backup power supplies in the facilities were not designed to provide backup electricity for a long period of time. "Some of these generators are old, while others have no necessary capacity to power the entire facility. Thus, generators have been proven not to adequately meet the increasing demands during loadshedding in health facilities, hence some hospitals are left without choice but forced to switch off some critical areas, which now compromises patient care," said Phaahla. He added that this is why provinces like Limpopo have resorted to putting elective surgeries on hold until further notice.
While the move by the department to exclude some hospitals from loadshedding was done in conjunction with other departments, from a legal point of view, Mahomed says, "The law has to be changed to make us critical service areas so that we can be excluded because we don't want another government coming in and changing, or Eskom changing, the rules of engagement."
The Democratic Alliance (DA) has since called on the health minister to work with the National Energy Regulator of South Africa (NERSA) to amend the relevant rules so that hospitals and medical centres are excluded from all future instances of loadshedding.
How it will work
"Discussions are ongoing to exempt all hospitals according to the priority lists submitted by provinces," says Mohale. "Due to the complexity of electric configurations, some hospitals are connected on the same feeder lines with Eskom customers, which makes it difficult to immediately exempt. In such cases, they will still use generators and UPS systems until a long-lasting solution is found."
Phaahla said that the department will work with Eskom to install new feeder lines for hospitals that are currently using the same lines as communities. This will make it possible to keep the power on at a hospital while it is off in the surrounding area.
It is however not clear who will be responsible for paying for the installation of the new feeder lines. Mahomed suggests that asking health departments to pay would be unfair and would put a strain on the healthcare budget for patients.
The City of Johannesburg's power utility City Power has also said it is difficult to exclude all the facilities in the City of Johannesburg from loadshedding because of the network configuration.
"From the list we received, there are over 130 health facilities, including clinics and hospitals within the City of Joburg. On that list, and based on the assessments of our network, we are only able to exempt about ten facilities, for now, in our supply network," the metro said in a statement.
Other alternatives
Mahomed suggests green energy sources should be considered for health facilities.
Phaahla has indicated that government is doing just that, although it is not yet clear whether any such projects will in fact be implemented.
He said last week that they are considering a phased approach to solar power installations and that feasibility studies will first have to be done. He also pointed out that such installations are not yet budgeted for and that money will have to be found.
"Solarised energy will be prioritised for areas such as theatres, Intensive Care Units, and High-Tech and advanced equipment," he said.
But while solar energy solutions might be on the distant horizon for public healthcare facilities, the backup power option that facilities will continue to rely on for the foreseeable future remains diesel generators.
Diesel budgets blown
Since most health facilities still depend on generators for backup power, keeping the lights on during loadshedding has been costly. The responsibility of running the generators and buying fuel (diesel) comes out of the budget of that individual hospital, Mohamed explains. He says there are provisions made in the budget for running generators for emergencies, but not for the type of loadshedding we've been experiencing.
"That (extra) money comes from the healthcare budgets and the proportion normally used for patient care." He says this means money is used that is meant for delivering healthcare to patients.
Mahomed is also concerned that the department will run into financial problems. "If you listen to the minister, a lot of the budget allocated for diesel for emergencies has already been used and now they are supplementing it with budgets from elsewhere, and is not clear where that money is coming from."
In Gauteng, for example, the provincial health department in response to a question by the DA MPL Jack Bloom said there were 181 generator failures at the province's health facilities this year due to diesel shortages. The province already spent R42 million running their generators - almost double the amount spent last year.
According to Mohale, most hospitals have already exhausted their budget for fuel, which means that they are forced to shift budget from other line items to keep lights and machines on in critical care departments.
"But the shifting doesn't affect the budget of critical services, but mainly support services items," he says. He says discussions with Treasury are ongoing regarding budget issues.
Michele Clarke, health spokesperson for the Democratic Alliance, says all health facilities should be exempted from loadshedding. While many hospitals do have generators and UPS systems, she says, they cannot cope with the volume of loadshedding the country is forced to deal with at the moment. She says generators and UPS systems were not designed for these conditions and are breaking down.
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Clarke is also concerned that the sheer volume of loadshedding is depleting budgets faster than anticipated. She says this is something Treasury would have to consider in the MTBPS.
Private sector also affected
According to Andre Nortjé, National Environmental Sustainability Manager for Netcare Limited, the private sector is not currently exempted from loadshedding and hospitals are experiencing the same loadshedding as other corporates and businesses. However, he says that it does happen on occasion that some of their facilities are spared from loadshedding because they may be connected to a specific business that is exempt. He says Netcare Sunninghill Hospital, for example, is on the same line as Megawatt Park (Eskom).
While all Netcare facilities have standby generators, Nortje says that with the increasing loadshedding frequency, the facilities have used more than double the amount of diesel compared to previous years. "We have no option but to make provision for backup power to keep our hospitals operational," he says.
Nortjé says Netcare has also invested in green energy. Currently, Netcare has more than 14MWp of Solar PV generating capacity installed on its facilities' rooftops and carports. However, he says that these systems are grid-tied solutions and do not have battery storage included. As such, when loadshedding occurs, or the grid drops away, the solar systems also switch off.
"This is done to protect the generators from damage given that this is the hospitals' ultimate fallback in providing care to our patients. As battery solutions continue to develop and grid interruptions continue to occur, Netcare is investigating full battery backup solutions as an alternative to the use of generators," he says.
Just like public sector hospitals, private hospitals are also spending more on diesel than they had budgeted. "Unfortunately, we are not remunerated by medical schemes or private patients for the additional costs to ensure that safe, sustainable care is delivered without disruption to our patients," says Nortjé.
