What is at stake in South Africa's upcoming provincial elections when it comes to healthcare? Ufrieda Ho put questions to five political parties about their plans to get Gauteng Health on track to better healthcare services after the polls. Only two parties responded.
If the available polls are to be believed, the ANC could lose power in Gauteng, or end up governing in coalition with one or two other political parties. Such a political shift after 29 May raises the question of what political parties are putting on the table specifically to prioritise healthcare in Gauteng. We approached several key parties directly to ask how they intend to fix Gauteng Health beyond the broad strokes of national manifesto promises.
First the context... and some low-lights
Over the last two decades, Gauteng health has often made the headlines for the wrong reasons. The province's health department has been the subject of Special Investigating Unit investigations and damning findings from South Africa's health ombud. Low-lights range from the Life Esidimeni tragedy in which 144 mental healthcare users lost their lives in 2016, damning SIU findings against former MEC for Health Brian Hlongwa relating to alleged corruption worth R1.2 billion in around 2008, a devastating fire at Charlotte Maxeke Hospital in April 2021 and a tardy recovery from the fire, massive alleged corruption relating to the procurement of personal protective equipment during the height of the COVID-19 pandemic, and alleged corruption at Tembisa Hospital of over R1 billion and the assassination of Babita Deokaran - the official who blew the whistle on the alleged corruption - in August 2021.
The province's health department has also often been in the headlines for things like food shortages in hospitals, shortages of colostomy bags, long waiting lists for cancer treatment, and poor security at some health facilities. In recent years, crumbling infrastructure has seen water pipes burst and flood theatres, causing surgery backlogs at Chris Hani Baragwanath hospital. Unmaintained plumbing and sanitation rendered toilets at Rahima Moosa Mother and Child Hospital unusable. Parts of the hospital campus were left in a stew of seeping sewage for months. At Helen Joseph Hospital, thermostats in operating theatres could not be repaired, leaving operating theatre temperatures too hot for surgeries to be performed. In some cases, as with food supply and security, the tender processes that underpin these services appears to have gone awry.
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Healthcare workers who speak out about poor conditions at health facilities, such as Dr Tim de Maayer have come under huge pressure from the department (De Maayer was eventually vindicated by a report from the health ombud).
That the Gauteng Department of Health should be a target for corruption is not surprising. The province's total budget for the 2024/2025 financial year stands at R64.8 billion. This is more than 20% of South Africa's total public sector spending on health and more than is allocated to any other department in Gauteng. Even so, the province has well-publicised shortages of healthcare workers and many senior posts in the provincial health department are vacant or held by people serving in an acting capacity.
Political health leadership in the province has been unstable. Under the three administrations since the 2009 elections, the province has had seven different MECs for health (eight if one counts Qedani Mahlangu's two stints as two rather than one). This means a health MEC in Gauteng has on average lasted roughly two years over the last decade and a half.
What's needed
Attempts to support the Gauteng Department of Health from the outside seems to have faltered. Professor Shabir Madhi, Dean of the Faculty of Health Sciences at Wits University, says that the implementation of a memorandum of agreement (MOA) signed in June 2022 between Wits University and the Gauteng Department of Health remains in limbo. The agreement relates to developing a framework to ensure greater joint accountability for staff who have appointments with the health department and the university.
"Unfortunately, and despite many attempts on the part of the University, the MOA is yet to be implemented," says Madhi. "It also means the university is unable to contribute more to supporting the Gauteng Department of Health or to have greater input when it comes to the management and functioning of healthcare facilities as it relates to patient care. It eventually affects how the university can carry out its medical training programmes at hospitals."
More broadly, Madhi says what's needed beyond 29 May is a health department that decentralises decision making to hospital level. Hospital boards also need to be revived to be a competent and efficient layer of oversight.
"There needs to be a delegation of authority down to the facility level, and at the facility level, the management must be fit for purpose," says Madhi, adding that we need CEOs and board members who have experience and competencies in a range of fields from healthcare, finance, operations and management. He also called for new hospital organograms to be drawn up to match current needs with services. "There needs to be a clear scoping of the human resource requirements of healthcare facilities".
It's critical, says Madhi, that the departments of health and infrastructure and development work "in a coherent manner". This is necessary, he said, to ensure adequate maintenance, proper investment in infrastructure and fewer delays for work on critical facilities like hospitals.
Getting rid of political interference
For Professor Craig Househam, a top priority is to get rid of political interference in the running of health facilities and for effective, stable management to restore patients' and staff's trust in the department. Househam is a retired professor of paediatrics and child health and former head of department in the Western Cape health department. He was part of former Gauteng premier David Makhura's intervention team meant to address failings in the province's health department in 2017.
"An appointment process based on merit and proven capability needs to be created. And you also need a process to deal with people who can't and don't perform. You can't have a situation of people suspended on allegations of fraud and corruption, but without processes being finalised, they sit at home continuing to pocket a salary for months, even years."
The health sector is "unfortunately where the feeding trough has been", says Househam because health is a massive budget for provinces and because expenditure is largely made of provincial-level procurement. This opens up the potential for fraud and corruption.
Although Househam says the upcoming elections do offer citizens a way to hold a government to account, he also cautions: "One of the most striking things to me is, the health part of all the manifestos is either almost non-existent or superficial."
Spotlight put questions to five political parties on what specific solutions they are putting on the table for health in Gauteng. Our focus was on getting beyond national-level rhetoric and to get a clear sense of what concrete things parties promise to do to address the types of problems discussed earlier in this article. We received responses from the DA and RISE MZANSI. The ANC, EFF, and Action SA did not provide any substantive responses (you can see details of our efforts to get comment at the bottom of this article).
What the DA is offering
Jack Bloom is shadow member of the provincial legislature for health and has been in the legislature since 1994.
A first priority for the DA after 29 May, he says, is to employ hospital CEOs and HODs in full-time (not in acting) positions and to ensure that there is "strict separation" between political and administration functions in the department of health and the province's 37 hospitals.
"We need competent, honest people. Some of the best candidates are put off applying in the public sector because they know they either won't be considered because of cadre deployment or because they don't want to work within a corrupt system," he says.
Bloom believes that after 29 May there will be a reconfiguration of coalition government in the province. He says a political landscape change in this way could mean his party and its partners will be able to push for greater accountability, beginning with retraining the spotlight on finalising the legal case against Hlongwa involving allegations of fraud and corruption.
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The DA also promises to ensure that the budget is better managed and spent. "The health budget is massive ... and has kept pace with medical inflation. A bigger problem than the size of the budget is that the money has been looted or misspent and we see this with scandal after scandal," Bloom says.
The DA and its coalition, he adds, wants to strengthen the legislature's structures and how reporting from provincial oversight committees is done. This is to ensure greater transparency and responsiveness to address issues, says Bloom.
There also needs to be a quicker rollout of the Health Information System to digitise patient records that was put forward in the late 1990s already but is still not fully implemented, says Bloom.
Other priorities, he says, are to find ways to work with and protect whistle-blowers "so corruption doesn't get swept under the carpet" and for reports and recommendations, including those by the auditor-general and the health ombud, to be taken seriously and implemented within set timeframes.
What RISE Mzanzi is offering
Vuyiswa Ramokgopa is the party's Gauteng premier candidate. This is the first election that Rise Mzansi will be contesting.
Ramokgopa says the crises in the Gauteng Department of Health are a mirror of what has happened within the ruling ANC. "We see that there is a culture in the governing party in the province that is a culture of impunity, a culture that condones and shelters people who commit wrongs and it's literally to the cost of people's lives when it comes to health."
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After the elections, Ramokgopa says her party wants to see the establishment of an independent oversight committee made up of health systems experts, health practitioners and activists who can give direct input to the provincial health department.
She says that there also needs to be an accessible platform for any person to track "the journey" of tenders from how they were chosen to when they completed delivery.
The health budget should also be increased, Ramokgopa says, adding that the gap between funding in the public health sector compared to what people pay for private healthcare points to "chronic underfunding" for public healthcare.
For Rise Mzansi, strategies to boost funding also comes down to making it easier for public private partnerships (PPPs) to be put in place.
"The ruling party has been adversarial and suspicious of the private sector and the regulatory environment for PPP has been cumbersome," Ramokgopa says.
Another key focus for the party is on primary healthcare. Better management on everything from food safety, to encouraging healthier lifestyles and routine check-ups, Ramokgopa says, is a way to keep people healthier without needing chronic care or hospitalisation.
She says "whether we get one seat or 10 seats" after the 29 May elections, Rise Msanzi will hold the executive in the legislature to account and make legislative decisions that represent the citizens' wishes.
The other political parties Spotlight approached responded as follows:
ANC - Lesego Makhubela failed to respond to repeated email questions or to phone calls, SMSes, Whatsapp messages and calls over several weeks.
EFF - Nkululeko Dunga took a call from us, set a time for an interview, then failed to take the call. Dunga didn't respond to repeated follow-up calls, Whatsapp messages and questions over several weeks.
ACTION SA - No response was forthcoming from an email request and questions sent via the party's information email service. Herman Mashaba was contacted via a Whatsapp message. He asked for questions to be emailed to him to be forwarded to "Dr Kgosi Letlape who is our TeamFixSA on Health". No response to questions has been forthcoming and there has been no response to follow-up phone calls, Whatsapp messages or emails over several weeks.
