The Gauteng Department of Health has struggled this year to ensure that patients in the province's hospitals always have the food they need. In addition to several reports received by Spotlight from healthcare workers, the issue has also made the headlines. The Citizen reported that 26 of 34 hospitals suffered food shortages this year, Business Live reported that in response to the crisis the province would scrap the single supplier model for food supply, and News24 reported that several service providers have voluntarily terminated their contracts with the department.
Now it has emerged that the province's health department is piggybacking on a Limpopo Provincial Government food contract. The Gauteng health department insists it is all above board, but several critics are sceptical of the arrangement.
'Fishy Limpopo contract'
The issue came to the fore last week when Democratic Alliance (DA) MPL Jack Bloom released a statement describing the Limpopo contract as "fishy".
"There are 54 Limpopo companies listed as suppliers of food to Gauteng hospitals, but many are not in the food business, including 7 construction companies," Bloom wrote. "Why is an engineering company, a security firm, and a motor workshop supplying food? It looks like Gauteng is joining a Limpopo government scam to benefit from dodgy contracts with possible payoffs to ANC politicians."
The list of contracted companies together with the services they are contracted to provide can be seen here. Bloom appears to be right that the core business of many of the contracted companies is not to supply food.
Almost all of the companies are contracted to provide either "frozen chicken, fish, eggs, and dairy products" or "red meat, bread, fruits and vegetables". Only two companies are contracted to provide both.
The Gauteng Department of Health did not respond to a question from Spotlight as to whether they were aware that some of the food suppliers are construction companies.
The DA called for an immediate halt to the contract and "an urgent investigation into who authorised it and who benefits from it".
'Nothing untoward'
Bloom's statement referred to an answer he received to a question posed to Gauteng MEC for Health and Wellness Nomantu Nkomo-Ralehoko in the provincial legislature (which can be read here).
Asked in the legislature what the "assessed need" was to participate in the Limpopo contract, the MEC responded that: "The department experienced a shortage of food provisions due to suppliers awarded contracts via the request for quotation (RFQ) process not being in a position to deliver." She said the department will continue to participate in the Limpopo contract until the department has finalised its own contract.
At the time (30 October 2023), the MEC said just over R23.6 million had been spent by the Gauteng Department of Health on the Limpopo contract.
The Gauteng health department has denied in media reports that there is anything untoward about the arrangement.
"The Limpopo Department of Health has conducted a competitive bidding process in compliance with procurement regulations to appoint these suppliers...their process was audited by the Auditor General and found to be compliant," Health spokesperson Motaletale Modiba told EWN last week. Spotlight has attempted to verify this with the Auditor General but had received no response by the time of publication.
Spotlight sent several further questions to the Gauteng Department of Health about the Limpopo contract, their participation in the contract, and the department's plans for ensuring a reliable food supply. Modiba did not provide responses to our specific questions, but only sent us a document with the responses the MEC gave to questions posed in the legislature.
Why no local companies?
Bloom argues it is not possible that the department can't find local companies to supply products like bread and eggs to hospitals. He says he is also concerned about the extra transport costs that come with bringing in food from Limpopo to Gauteng.
"Competent people are needed at all levels to ensure that the required food is always supplied by reliable contractors who are paid in good time. Hospital management should be empowered to manage food contracts, with prompt payment in all cases," he says.
Sidewell Mbasa, provincial Chairperson of the Treatment Action Campaign (TAC), echoes Bloom's views. He says, "there are a lot of capable and reputable companies that can provide a better service".
When asked in the legislature why the provincial health department had not contracted Gauteng-based companies to supply food, Nkomo-Ralehoko only said "the department currently does not have a contract as it is in the process of establishing a contract for the provision of food."
Some suspect corruption
According to Rich Sicina, President of the Health and Allied workers Indaba Trade Union, they view the affair as a continuation of corruption in the department. "It's the continuation of looting taxpayers' money, looting state funds," he says.
"As a union we are very worried, it's demotivating to watch this happening in front of our eyes. People are dying in our particular hospitals; we have situations where we go days without food. And as a result, as healthcare workers, nurses in particular, we even go as far as hitting our own pocket to buy food for patients in the hospitals because obviously you cannot give a medication to patients when they're on empty stomach," says Sicina.
Bongani Mazibuko, provincial secretary of labour union Denosa, says in most cases, the decisions the department takes are frustrating them as a union and makes them feel like the department is not concerned about how these decisions affect their employees and the patients. He says that as a union they have previously engaged with the department on similar issues affecting healthcare workers and patients. The reoccurrence of such issues, according to Mazibuko, is a direct result of a lack of consequence management in the department. He says people who are not doing their jobs should be held to account.
A 'delicate ecosystem'
Dr Mvuyisi Mzukwa, chairperson of the South African Medical Association (SAMA), says food supply shortages in hospitals could have a profound impact on healthcare workers when they treat hungry patients. "Patients and healthcare workers find themselves in a very delicate ecosystem, and any disruption to this ecosystem affects multiple aspects of the health system," he says.
Mzukwa says healthcare systems strengthening is built on the foundation of good leadership and governance. This involves ensuring that strategic policy frameworks exist, including memorandums of understanding, combined with effective oversight, transparency, regulation, and accountability. "This will ensure that systems exist to deal with any contract management issues efficiently and effectively prior to the development of a crisis," Mzukwa tells Spotlight.
He adds that strong governance is characterised by appropriate investment and prioritisation of scarce resources to ensure equity and improved health outcomes.
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"Challenges with food supply at public hospitals is directly related to a failure in leadership and governance. We are reminded that there is a very complex and dynamic interaction that exists between health providers, healthcare users and decision-makers," says Mzukwa adding that these interactions can be strengthened by good leadership and governance; however, the opposite is also true where bottlenecks and dissatisfaction can inhibit progress towards providing quality healthcare services.
Healthcare workers not to blame
Rachel Moore, specialist surgeon and representative of the Progressive Health Forum, says that the fact that there have been so many failures on the part of the department without any visible repercussions for those responsible, means there is widespread, profound mistrust of the processes that are allegedly in place to address any issues (including food shortages in hospitals).
"So it is much easier and more concrete or immediate to blame the healthcare professionals and managers in a specific healthcare facility rather than directing complaints to the Gauteng Department of Health," she says.
Moore says this is yet another symptom of the dysfunction that is a hallmark of the current Gauteng Department of Health. "Awarding contracts and honouring the payment of suppliers are fairly basic processes, so the failure thereof simply reflects the gross ineptitude of those who have been tasked with ensuring the delivery of healthcare to the people of Gauteng," she says.
Note: A representative of the TAC is quoted in this article. Spotlight is published by SECTION27 and the TAC, but is editorially independent- an independence that the editors guard jealously. Spotlight is a member of the South African Press Council.
