by Jack Bloom MPL, DA Shadow MEC for Health
Note to editors: This speech was delivered during the 2018/2019 Budget Vote of the Department of Health in the Gauteng Provincial Legislature
Madam Speaker, this is the 25th Health Budget that I am speaking on.
Health is now the largest budget item for the first time, with a hefty 15.5% increase to R46.4 billion.
I wish I could say that it is a credible budget that will be spent efficiently and effectively on quality healthcare for our citizens.
I also wish I could say that the entire budget will be available to spend this year, but more than R6 billion of it will have to pay the accumulated debt of previous years.
The sins of the past continue to bedevil this department which has promised umpteen turn-around plans that haven’t worked out.
Let us turn the clock back to the 2006 health budget which was introduced by Honourable Member Brian Hlongwa when he took over as Health MEC from Honourable Member Gwen Ramokgopa.
The 2006/7 Health Budget was R10.4 billion, which was 30% of the total provincial budget of R30.5 billion.
Contrast this with this year’s R46.4 billion Health Budget which is 38% of the total R121.2 billion budget.
We have to ask why we have a department that is in crisis today despite a substantial boost in its budget, even accounting for high medical inflation.
The first Health MEC to talk about a turn-around plan was Brian Hlongwa in 2008. And guess which company was to do this turnaround? It was 3P Consulting, one of the first examples of state capture by a private company that enriched itself and allegedly paid benefits to him.
The result was a turn-around from a moderately competent health department to the seeds of the disaster that we have today.
Then we had the promised turnaround of former Health MEC Qedani Mahlangu. On 23 October 2009 the Star reported that she had “a plan of action for getting her financially disastrous department on track …(she) … committed herself to her turnaround plan.”
And every year since then we have more mentions of a turnaround plan even as the department deteriorates further.
I have no doubt that the current intervention team has made good recommendations, but I really doubt that they can be implemented with the poor calibre of many top managers, particularly in Finance and Human Resources.
How can it be that the department does not have an approved organizational structure, but only a draft that has to be ratified by the Minister of Public Service and Administration?
The staff establishment is inadequate and outdated as it is based on a population of 9.5 million in 2006, but our provincial population is now about 14.3 million.
This situation has been worsened by a circular to hospitals directing them to fill only 50% of vacant funded posts occupied by retired, resigned and deceased personnel.
I appreciate that the department needs to rein in personnel costs that are crowding out other expenditure, but this is a very crude way to do it, with terrible consequences for patient care.
I regularly get terrible stories about what happens when there is a shortage of critical staff.
For instance, this week, pregnant women who need Caesarean sections at the Far East Rand Hospital have had to sit in chairs for more than a day because of a shortage of doctors.
Concerned staff at the Charlotte Maxeke Johannesburg Hospital have been holding peaceful protests with placards that say “No freezing of posts, not another Life Esidimeni.”
Madam MEC, they are warning you, as are many others, and we know what happened the last time that warnings were ignored.
A more sensitive and consultative approach is needed to make the necessary changes to ensure that the department sticks to its budget while providing a quality service.
It needs a scalpel, not an axe, in this delicate area.
Madam Speaker, we need to make more progress with a proper health information system, which is an essential tool in making rational decisions, both to save costs and to provide the best care with the available resources.
And we also need to replace paper files with electronic files, but we are way behind schedule with the scanning to make this happen.
Another disappointing area is the failure to spend on machinery and buildings.
It is very disturbing that the capital budget has decreased from R2.15 billion last year to R1.88 billion this year, which is a 12.6% drop.
It is even worse going forward, dropping to only R928 million next year, which is a 50% cut.
This is calamitous when you see the backlog in building maintenance, and the need for new machinery and facilities.
I will deal briefly with 10 further areas of concern:
- In the 4th Quarter of the last financial year, only 74 (50%) out of 148 targets were achieved.
- We are slipping on the TB Patients’ treatment success rate, which is attributed to the lack of follow-up with lost patients. It is now at 83% instead of the 87% target.
- Poor data capturing is blamed yet again for being 46 000 below target for patients on Anti-retroviral treatment. This is surely an easy thing to fix, or is it covering up for the reality that we are indeed failing in this area?
- We normally do very well with immunization, but only achieved 80% instead of 97% immunization coverage for children under one years old.
- I am very concerned that cervical cancer screening is only at 50% rather than the target of 60%.
- The Priority 1 urban response rate of emergency ambulances is recorded at 79.7% within 15 minutes as opposed to the target of 85%, but I don’t believe this figure. We have a terrible emergency ambulance service, but every year there is a large under-expenditure on this item.
- Patients still suffer from long queues and waiting times for surgery, which is particularly serious in the case of cancer.
- The potential liability for medical negligence is now R22 billion, which is nearly half of this year’s total budget.
- There are too few secured beds in hospitals for psychiatric patients who are often placed in ordinary wards where they are a danger to themselves and others.
- Mental health NGOs are paid late by this Department and not assisted to comply with stricter standards.
Finally, Madam Speaker, the ailing state of public healthcare in this province should indicate caution with regard to the proposed National Health Insurance.
Why is there any confidence that the NHI will be run any better than the disastrous record of this department, and even worse disasters in other ANC-run provinces?
The same inefficiency and corruption would afflict a huge state-run health agency.
Even the small-scale pilot NHI project in this province was a failure.
We do need to improve both private and public healthcare and ensure that they work optimally together for the benefit of all our citizens.
Incremental, evidence-based changes will achieve far more than the grandiose schemes of Health Minister Aaron Motsoaledi who has presided over massive health failures for years.
The DA will not be supporting this budget.