The Free State public healthcare system has been in a state of dysfunction for many years. We hear endless stories of ambulances that do not arrive leaving family members cradling their dying loved ones without medical assistance. Too many reports of stockouts, not just as empty clinic cupboards, but of people resorting to rationing their medicines or spending pensions or grants to pay for these lifesaving treatments. Countless testimonies of people reluctant to use clinics and hospitals because of how they have been disrespected and ridiculed by nurses and doctors. The pilot of National Health Insurance (NHI), an effort to ensure healthcare is equal and accessible to all, has been a disaster in the Thabo Mofutsanyane. The repeated evidence of trauma, loss and injury in the province has been mounting for too long.
The Treatment Action Campaign (TAC) has been working in the Free State since 2009 and continues to represent users of the public healthcare system and campaign on critical issues related to the quality of and access to healthcare. We currently have a network of 24 branches in four districts in the province including Lejweleputswa, Mangaung, Fezile Dabi and Thabo Mofutsanyane. Through these branches we monitor service delivery at a number of clinics and hospitals. Our members are the people who need the public health system to work, so they are the first to notice when it does not.
We see first-hand the impact the broken public healthcare system has on the communities in which we work. Investigations made by both the South African Human Rights Commission in 2007 and the Integrated Support Team in 2009 initially highlighted the severe challenges in the Free State. In 2015, the People’s Commission of Inquiry into the Free State Health System raised the stakes in enabling public healthcare users to tell their own stories of this dysfunction. The Commissioners found that little had changed since those early investigations, and that it was plausible the situation had gotten even worse.
At the time, our attempts to engage constructively with former MEC of Health Malakoane were all rejected – and the province continued to limp from crisis to crisis. His removal gave new hope of turning the dire situation in the province’s public healthcare system around. However, despite more open engagement with recently reshuffled MEC of Health Butana Komphela, the situation remains in crisis. The health department remains under provincial administration1. We need new MEC of Health Montsheng Tsiu to show real leadership and accountability in addressing the crisis. We need an urgent turnaround strategy and plan on implementation to ensure everyone can access the dignified and quality healthcare they deserve and that is enshrined in the Constitution of South Africa.
Each of our branches in the province has adopted a primary healthcare facility local to them and have been monitoring the state of services at these facilities since November 2017. The results highlight a number of critical concerns with regard to the state of services at clinics and community healthcare centres. A summary of the results of data collected so far is provided below.
The monitoring tool used has 24 questions based on the services and quality of service that a primary healthcare facility should offer. The questions, developed in consultation with TAC members, are designed to address the key concerns for users of the public healthcare system – and as such should be seen as complimentary to the more systematic and operational monitoring conducted by the Office of Health Standards Compliance (OHSC). The monitoring was conducted by TAC members trained in the use of the tool. In addition to monitoring facilities, TAC branches engage with members of the community to understand the challenges and collect testimonies and complaints that relate to these concerns.
The data collected by our branches corresponds to the worrying picture of our public healthcare system painted by reports published last year by the OHSC. According to the OHSC report, facilities should score at least 80% to claim an acceptable level of care – yet in Free State of 53 clinics inspected by the OHSC (not necessarily the same facilities as monitored by TAC) only 9% of the clinics are performing at 50% or above and none above 70%
Despite ongoing interventions, the situation in the Free State remains at code red. Persistent challenges continue to plague the provincial health system that require urgent improvement by the Free State Department of Health. We outline our concerns and demands in this new report that has been sent to the Health MEC in the province.