Madam Speaker, this is the 27th time that I am speaking on the Annual Report of the Gauteng Health Department.
This report covers the period from April 2019 to March 2020, so it is virtually all before the great calamity of the Covid-19 pandemic.
A health system that was already under strain, with huge backlogs, was ill-prepared for this new health threat.
We will see the outcome in the next annual report, but in this report, 103 out of 159 targets were achieved. This amounts to 65%, a marginal increase from 63% the year before.
There are distressing failures in key areas.
This department used to boast 100% immunisation coverage, but the immunisation coverage under 1 year olds was 87% compared to the target of 98%. The measles second dose coverage was only 80%.
It makes me worry how the mass anti-virus vaccinations for adults will proceed when we are falling behind with ordinary child vaccinations.
Another worry is that the biggest disease killer in South Africa is still Tuberculosis (TB), but the TB treatment success rate went down to 82% from 84% in the previous year. Only 62% of TB patients co-infected with HIV/AIDS are receiving ARV treatment instead of the target of 90%.
Furthermore, 9.4% of TB patients were lost to follow-up compared to the target of 5.5%, and the TB multi-drug resistant treatment success rate was at 55.1% compared to the target of 60%.
I am also distressed at the continuing failure to provide 100% vital and essential medicines as there was only 95.5% availability. This is particularly hard on psychiatric patients who cannot be easily switched to other medication.
An important indicator that is missing from the annual report is the number of patients on waiting lists for surgery and the average length of time they wait for operations.
The former MEC for Health promised that this indicator would be included in the future, so I hope it is in the next report.
I am very concerned that the surgery backlogs have surged because of the cancellation of much elective surgery during this pandemic. We need to know the extent of the backlogs and what special measures are being taken to reduce them.
I get heart-rending appeals from people who cannot see because of cataracts, or need a hip operation to walk, or even a cancer operation that has been delayed.
The surgery lists were already unacceptably long before this epidemic – I shudder to think what they are now.
The extra staff that have been hired because of the epidemic will hopefully assist in speedily reducing these backlogs, but the private health sector should also be brought in on a contract basis.
The root of the problem in this department is poor management. It leads to gross inefficiencies and allows corruption to flourish, as we have seen with the PPE scandal.
Madam Speaker, it is nearly seven years since the Honourable Premier promised in his inaugural address that there would be an “urgent turnaround” in the Gauteng Health Department.
But every year the Auditor-General identifies the lack of controls, and every year nothing much is done to fix it.
It is absolutely vital that a health information system is finally implemented. I remember the very first Health MEC Amos Masondo promising in this House more than 20 years ago that a health information system would be introduced.
There is currently a court case about a R1.2 billion contract awarded during former Health MEC Brian Hlongwa’s tenure for a health information system that should have been up and running ten years ago.
In the last five years, this department has had four health MECs, two heads of department and now a plethora of senior acting positions waiting to be filled.
The Honourable Health MEC has inherited a real mess. My advice to her is to try and get at least this one thing right – a functioning health information system so that you can properly assess where money is being spent, otherwise you are largely flying blind.
From the patient point of view, the paper files that lead to long queues and often get lost, should finally become history.
Unfortunately, according to this annual report, zero hospitals had implemented the integrated health information system compared to the target of 100%.
Zero hospitals had Electronic Health Records linked to the Provincial Heath Clinical Data Repository instead of the targeted 37 hospitals.
And zero PHC facilities had Electronic Health Records linked to the Provincial Heath Clinical Data Repository instead of the targeted 48% of facilities.
It is a zero, a zero and a zero in a vitally important area.
There is actually a lot of budget to spend, but the spending is inefficient and is often directed to the wrong areas.
The Auditor-General identifies irregular expenditure of R2.3 billion for the year under review. And fruitless and wasteful expenditure amounted to R9.3 million, largely due to interest accrued from litigation.
There was a total underspend of R905 million, of which R698 million was surrendered back to the Revenue Fund. Can you believe it? The needs are so great, but a sizable amount of money is not spent!
Every year the Audit Committee identifies the same 22 key strategic risks. They include the following:
• inadequate access to quality health services for mental health patients
• increase in maternal, new-born, infant and child morbidity/mortality
• high death rate due to increase in the number of HIV and TB infections
• financial losses due to litigation
• fraud and corruption
• aging infrastructure and health technology
• shortages in pharmaceutical supplies
• inadequate Human Capital Management
• Serious Adverse Events
These risks really need to be minimised as soon as possible.
The MEC has the opportunity now of filling all the senior vacant positions with top class, incorruptible people. No more cadre deployment! Whoever can best get the job done should be appointed.
The Honourable Premier appointed a high-level intervention team in November 2017 to fix the deep-rooted problems in the department. It had very good people, including Professor Craig Househam, the former head of the Western Cape health department.
They made good recommendations, but they were not implemented.
Yet another intervention team was appointed by the Honourable Premier in December last year. I am sure that they will also make good recommendations, but they will fail again unless the right people are in the right jobs and they do what needs to be done without fear or favour.
Madam MEC, I hope you are prepared to be tough and take on all the entrenched interests in your department.
If you do this, the future annual reports will look a lot better than this one.