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DA calls on MEC Vadi to hold corrupt department officials accountable

by Dr Neil Campbell MPL – DA Gauteng Spokesperson on Roads and Transport

The discovery of the fraudulent issuing of vehicle licence discs by officials in Benoni and other areas is long overdue.

Using deceased vehicle owners licence accounts to dump ‘bad’ debt of living, non-compliant vehicle owners for a fee has cost the fiscus at least R 80 million.

The Road Traffic Management Corporation must be commended for uncovering this rampant corruption.

The Auditor General has pointed out a lack of efficient systems and management by Gauteng MEC for Roads and Transport, Ismail Vadi’s department for several years yet there has been no improvement.

Corruption is rife within most Driver Licence Testing Centres, Roadworthy Centres and registering offices. MEC Vadi and the ANC continue to preach about being hard on corruption while allowing it to fester unchecked in areas where they know it exists.

The electorate is not fooled by cheap talk.

Action rather than hot air is necessary from both MEC Vadi and Premier David Makhura to root out systemic corruption in the department and the centres that it manages.

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More than R6 billion of health budget to pay for accruals

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.

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Gauteng Roads and Transport budget not pro-poo

By Dr Neil Campbell MPL, DA Spokesperson for Roads and Transport

Madam Speaker,

As we meet once again to debate the various budgets of the Gauteng Provincial Legislature I had hoped to be pleasantly surprised by a novel, imaginative and appropriate budget for the Department of Roads and Transport, because the ANC has assured us that there would be real change from the corrupt Zuma administration to a ‘New Dawn’ under President Ramaphosa.

Alas, in describing this budget the word disappointing would be a euphemism for the dull, robotic, unimaginative and retrogressive document which is served before us today.

We all know of the huge lack of affordable, accessible, punctual, safe and reliable public transport systems in Gauteng but despite the ruling party’s claims of being pro-poor the allocation for bus subsidies, which certainly aids the poor, has been irrationally reduced while the subsidy for the Gautrain, which caters for the relatively well-heeled, has been increased not only this year but every year of the Medium-Term Expenditure Framework (MTEF).

The ongoing battles between minibus taxi associations continues to claim lives.  I could not locate any budget being made available to try and resolve this problem.

The relatively recent warfare between metered and e-hailing taxis is also untenable. The latter are denied their constitutional right to free movement under threat of death and property damage around our transport centres, by the former.

Yet here too I could find no allocation of money by the Department to fight this impediment to the freedom of individuals.

Madam Speaker,

Integrated transport hubs and the promised single ticket system which would solve many problems are also largely unfunded, and when long delayed transport centres are eventually opened the taxis and shops which were to use the centre are either bankrupt or have moved to pastures new. Does this sound like the actions of a pro-poor governing party? I certainly think not.

Much blame has been laid by our Department at the door of the National Department of Transport regarding poor systems and procrastination. The ANC is a past master at passing blame especially between spheres of government, but MEC Vadi, you have the forum through MINMEC to influence the Minister and other MECs in speeding up the resolution of transport problems, yet you fail to spearhead such transport solutions for the people of Gauteng.

With the rise of the price of oil and the weakness of the Rand, due to poor ANC economic policies and corruption, fuel prices have escalated alarmingly which has had a negative effect on people’s pockets. The price of anything which requires transportation rises and the impact is greatest on the poor. Crony deployment in most of the SOEs, like Eskom, SAA, PRASA and Denel has resulted in ratings agencies eschewing our country as a place to invest and the National Treasury is chronically short of money.

In this abysmal economy the recent VAT increase was hard to bear but higher taxes on fuel have again been used as a quick source of revenue despite the huge negative effect it has on the cost of living. Gauteng motor vehicle licence fees have again been increased well above CPI, further increasing transport costs.

Nothing in this budget speaks to innovation nor is there any glimmer of hope for better public transportation. It contains more of the same old hackneyed, formulaic marking-time which has characterised this department over the last several years.

I appeal to you MEC, on behalf of all of us in Gauteng, to use your considerable powers of persuasion to buck up delivery from the NDT and to make your department an innovator in transportation solutions.

I thank you Madam Speaker.

 

 

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Community service doctors short-changed by Gauteng Health Department

Four young community service doctors who were granted posts at the Steve Biko Academic Hospital in Tshwane, have been working without pay since the beginning of the year.

The National and Provincial Departments of Health are required to create community service posts for health professionals who have completed their academic courses and are then required to ‘pay-back’ to the state by working in state facilities.

This employment is remunerated and eases the burden in state hospitals as a new cohort of professional’s report for duty each year.

Placement is thrashed out each year by the national Department of Health with input from Provinces and SA Military Health Services, all of whom provide posts for so-called “com-serve” professionals.

Full registration with the Health Professions Council of SA is only granted after completion of the community service period.

A note dated 29 January 2018 from the hospital HR Department informed these doctors that they would receive no salary as there were no community service posts available at the hospital – despite the hospital having received duly completed appointment notes from the NDH at the beginning of the month and having assigned these doctors to wards where they worked.

On 2 February 2018 the hospital CEO offered them a ‘loan’ to assist them with expenses but stated that because the Gauteng Department of Health has no money, they did not have posts, and would not be paid as a decision still had to be taken as to where and when posts would be made available and in which province.

It is illegal to not pay a person for work done.

These doctors have relocation and living expenses and have signed year-long accommodation leases in Tshwane based on official letters of appointment.

This callous and cavalier approach to people is reminiscent of the attitude adopted with the Esidimeni patients and calls Gauteng Health MEC, Gwen Ramokgopa’s integrity into question.

It is high time that community service posts were properly administered, remunerated and assigned. MEC Ramokgopa must rectify this fiasco immediately as these doctors have a crucial role to play in ensuring the well-being of the province’s residents.

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Gauteng Transport owed R210 million by Government departments

The Gauteng Department of Roads and Transport (GDRT) is owed over R200 million by other government agencies but has been disallowed to collect this money by Provincial Treasury.

This was revealed to the Gauteng Transport Portfolio committee on Friday.

The top ten defaulters are:

  1. Gauteng Department of Health: R 124 696 156.17
    2. National Office of the Chief Justice: R 35 487 797.77
    3. National Department of Home Affairs: R 19 677 435.19
    4. Gauteng Department of Social Development: R 6 534 131.13
    5. SANDF Works Formation: R 5 069 967.43
    6. Department of Justice and Constitutional Development: R 5 015 949.29
    7. National Department of Social Development: R 4 344 830.08
    8. Gauteng Department of Agriculture, Rural Development and Environment: R 4 327 722.26
    9. National Department of Energy: R 2 689 201.39
    10. National Department of Rural Development and Land Reform: R 2 497 567.47

Total: R 210 340 758.09

Despite several attempts by officials at the self-funding G-Fleet, an entity of the GDRT, to turn-around the business, it is instead being hamstrung by outstanding hire fees.

Although not profit-oriented, G-Fleet has the potential to radically decrease governments spend on transport, but provincial treasury has not allowed the collection of the money owed, citing the collapse of government services as the reason.

The entity is currently under an acting CEO because the previous CEO and CFO are facing disciplinary action for financial mismanagement. G-Fleet has a workable strategy to revitalise itself which includes the cutting off of fuel card credit to default payers, but this has been countermanded by the Gauteng Cabinet which has dashed these plans.

The main defaulter, Gauteng Department of Health (GDoH), is technically bankrupt due to poor management over many years. GDoH itself is owed substantial monies by other provinces, SAPS, Correctional Services and other countries.

It is high time that intergovernmental debts, including the payment to local authorities by Provincial and National governments for rates and utility services are settled but that would reveal exactly how much financial trouble many government departments are in and is unlikely to happen.

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Mental illness no longer a taboo subject

Today, the DA in Gauteng marks World Mental Health Day and calls on all residents in the province and the country to break the stigma of mental illness and to seek help, should anyone be suffering in silence.

There is no reason to hide, feel left alone and to not speak up if you are suffering from any mental disorder.

According to a study conducted by the London School of Economics and Political Science, 4.5 million South Africans suffer from depression.

Seeking help is key to getting the right support and medication. The Gauteng Department of Health together with municipal clinics offer services to residents in need.

The two most common mental disorders that have an impact on many people’s abilities to work productively are anxiety and depression.

The DA encourages all employers to create an open environment whereby employees feel free to discuss and get treatment for any mental disorder.

World Mental Health Day coincides with the day that alternative dispute resolution hearings are presided over by former Deputy Chief Justice Dikgang Moseneke on the Esidimeni tragedy in which at least 118 mental patients died.

Many lives could have been saved and thus it is of utmost importance that anyone suffering from a mental disorder seek professional help sooner rather than later.

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Bapsfontein weighbridge down for 184 days

The Bapsfontein Provincial Weighbridge, which is situated on the busy R25 corridor that links Johannesburg with Groblersdal via Kempton Park and Bronkhorstspruit, has not been operational for a total of 184 days, or more than 6 months, between April 2015 to date.

According to a replyto a Democratic Alliance (DA) written question from the Gauteng MEC for Roads and Transport, Ismal Vadi, the Bapsfontein Provincial Weighbridge was out of service, thus compromising road safety, during the following periods:

Date Number of Days
03 November 2015 – 08 December 2015 35
16 July 2016 – 19 August 2016 64
13 March 2017 – 06 July 2017 85

This is a crisis that compromises road safety efforts. According to Arrive Alive,“overloaded vehicles threaten road safety and are contributing to many of the fatal accidents on our roads. The overloaded vehicle will not only put the driver at risk, but also passengers and other road users.”

Weighbridges are important in ensuring that vehicles operate on the country’s roads legally, as vehicles, especially busses and trucks, are only permitted to carry loads of a certain amount. Should a vehicle carry a load that is more than which it is certified to carry, it presents a risk to the driver, occupants and road-users.

The DA takes road safety very seriously as road fatalities have negative impact on society and the economy. We will thereforewrite the MEC to ensure that weighbridges across Gauteng are in optimal working condition.

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Report on the Portfolio Committee on Health visit to Accra, Ghana, July /August 2017.

Monday 31st July 2017

After considerable delay the joint delegation of Health and SRAC met with the Deputy Speaker of the Ghanaian Parliament who extended a welcome.

Parliament was good to the delegations in providing transport and two parliamentary staff to accompany our groups.

We enjoyed a visit to the Kwame Nkrumah mausoleum.

We then underwent a very basic lecture on health regarding exercise and non-communicable diseases presented by the parliamentary doctor. We learnt that 6 out of 10 deaths in Ghana are due to non-communicable diseases, although malaria accounts for 17.3% of all deaths and is the most common cause of death.

We were then given an opportunity to visit the Parliamentary clinic which is used by politicians and staff and which was rather well equipped with psychology, radiology, diagnostics, physiotherapy and even a full medical laboratory on site.

We were then taken to lunch by the representative of Parliament.

Tuesday 1st August 2017.

Again the whole parliamentary campus was chaotic. After much delay we were taken into the House where a session was about to begin. During the sitting we were all welcomed by the speaker.

We, both members of SRAC and Health, then met with a members of the Health and Youth, Sports and Culture committees. We had a rather cursory and rushed exchange of ideas.

A meeting with the Health Minister was cancelled due to his non availability.

Wednesday 2nd August 2017

We were welcomed by the Ghana Coalition of NGOs in Health at their headquarters. They have been in existence for 17 years and claim to be the most credible organisation of its kind in Ghana. It is non-partisan and has a seat on the Heath Committee of Parliament. It is easily able to secure TV time and claims to represent the Ghanaian people. It comprises 417 organisations either faith based or NGOs and Community based groups. It has 10 regional branches and has a presence in 201 of the 216 Districts of Ghana.

It concentrates on community medicine and identifies gaps left by the Health Department. Often there is insufficient funding for all they need to do but the vaccination programme has been one of their successes with almost 100% of children being vaccinated. However cases of polio still occur.

We were then taken to a facility (National Vocational Training Institute) where vocational training takes place. The SRAC committee was already there and we were not properly introduced nor did we receive any documentation. We toured the facility which really had no benefits for the health Committee whatsoever.

Thursday 3rd August 2017

We were received by the CEO and his Deputy of the National Health Insurance Scheme.

The NHIS was founded in 2002 and requires the payment of a registration fee of about 10 to 50 Cedi ($US 4 to $US 15) which is their annual ‘premium’. After initial payment there is a one month waiting period. However, despite legislation making NHIS membership compulsory, only 42% of Ghanaians and expats with permanent residence pay this fee. The CEO alleged that foreign nationals on the NHIS abuse the system. Mainly young people and indigents do not pay leaving the NHIS to fund the sick and elderly. The lack of youth results in anti-selection for the NHIS. Indigents with no NHIS are not afforded treatment and simply are tended at home or die. Employers pay a 5% health tax based on employee salaries and the NHIS also gets 2.5% of this 5% tax.

The budget of 2.2 B Cedi ($US 600,000) is mainly funded by government (1.9B Cedi). The difference is made up of grants by foreign powers and a few co-payments. Government receives its funding from a 2.5% which is added to the 15%VAT and is collected along with VAT. This is not ring fences and causes numerous problems with government using the levy for other more pressing issues, which results in late payments.

The NHIS approves of the private sector hospitals and providers (which is small about 25-30% of all healthcare and which the NHIS wishes to grow.

Certain people are treated despite being unregistered. These include those under 18 and those over 70 years of age, handicapped and pregnant individuals.

Most private hospitals and doctors contract with the NHIS and treat at (lower) NHIS rates for NHIS patients. They have both private and NHIS practices.

Parliamentarians enjoy private Medical aid and do not fall under the NHIS.!!!!!

40% of NHIS income is paid in salaries.

The CEO stated that having been in RSA that the RSA is 80% more technologically advanced that Ghana.

The system is based on primary healthcare and has many CHEBs (Community Health Bases) which often have only a visiting nurse and no building or other infrastructure.

From here referrals go to Health Centres where midwives and physician assistants are available.

Up referral is to District Hospital where a doctor is usually available.

Thereafter up referral is to regional hospitals –each region has at least one and Accra has 3. There are 14 nationwide.

Thereafter referral is to tertiary (teaching) hospitals where specialists are available. There are 5 in Ghana.

This interesting meeting was cut short by the committee chair.

We then visited the “Ridge” Regional Hospital in Accra. It is brand new and only half used with many empty wards.

It was interesting to note that triage procedures used in Casualty and in Mother and Child Treatment protocols are copied from RSA. IT would have been more beneficial to visit a more typical (older) hospital.

Although much time was wasted on this trip I learned that NHI in Ghana, just like in Germany, France and Britain is fraught with problems and seems to be economically unsustainable. Ghana wishes the private sector to relieve it of a substantial part of its burden.

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Esidimeni legacy plagues mental health NGOs

At a meeting of the Gauteng Portfolio Committee on Health in Thokosa, Ekurhuleni yesterday it was revealed that only 38 mental health NGOs had complied with the requirements to receive licences from the Mental Health Directorate.

91 NGOs do not comply with all the new criteria required for full registration.

Amongst the problems facing the NGOs in attaining registration status are:

• Requirements for rezoning of their premises which could cost up to R70 000 and take a considerable time to obtain;
• A lack of written, and in some cases any, communication from the Directorate including minutes of bilateral meetings; and
• The costly, though necessary, requirement to obtain police clearance for all NGO employees.

Additionally, an audit process from the Health Department had identified non-expenditure of grants by NGOs as a problem when in fact late grant payment by the Department of Health was the source of this problem.

Quarterly grants covering the period from January to March were received only at the end of March which placed huge difficulties on NGOs who had to rely on donations for that period and then could not ‘waste’ money once the three month of grants arrived so late in the quarter.

In the interim no licences have been issued and all NGOs, even those who are fully compliant, operate on temporary licences.

It is gratifying to note that such a thorough process has replaced the licencing fiasco that resulted in the Esidimeni deaths, but it is taking far too long to resolve and despite the announcement of a 20% increase in grants – these will be eaten up by bureaucracy and licencing requirements.

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Transport investigation will keep Competition Commission busy

The Democratic Alliance welcomes the long-overdue investigation into road transport announced by the Competition Commission.

The transport industry is beset by corruption, violence and even murder.

As far as busses go they still operate on outdated, apartheid-style routes and subsidies and are characterised by un-roadworthy, unreliable vehicles.

The taxi industry, a vital source of transport for many thousands of commuters, is tainted from some corrupt owners through the drivers and loaders, to the very Departments of Transport set up to regulate them.

The ongoing Uber versus the metered taxi services battle caught regulators by surprise and there is no uniformity in how various provinces have dealt with the new app-based service.

I wish the Commission every success in dealing with these problems which have stumped all previous ministers of transport, albeit that they were poorly equipped to tackle the problems their ministries faced.

I would suggest that the Commission spends some time reading the multiparty report of the commission of inquiry into taxi violence as adopted by the GPL last year to gain insight into the complex issues they face.

The DA will support any effort to bring peace and transparency to a rotten industry.