The Limpopo health system is plagued with severe staff shortages and a huge loss of experienced senior staff who have been seduced by better pay and working conditions in private hospitals. There are regular reports of theft of medicines, equipment that is aged, missing or broken, and ambulances that are reduced to mortuary vans because they take forever to arrive, if they arrive at all. Facilities are dangerously overcrowded. There are too few doctors and nurses. Inferior filing systems mean people wait an excessive number of hours to be seen, at times with fatal consequences. Ongoing medicine stockouts and shortages persist. Public health buildings are in disrepair, and some lack safe running water. When local clinics prove to be under-resourced, public healthcare users are referred to facilities in bigger towns. For a province where 80% of people live in rural settings, this means travelling long distances, at significant expense, to try to access treatment and care.
According to the provincial health department’s budget speech, Limpopo has the lowest expenditure per capita on primary healthcare in South Africa. Worryingly, between the 2015/16 financial year and the 2016/17 financial year, this even spend dropped by 3.8%. It is particularly low in Mopani, Vhembe and Capricorn. In contrast, instead of paying for frontline services, there is high spending on district management in Waterberg, Mopani, and Vhembe.
The reality is that the health system in Limpopo is broken. It is failing hundreds of thousands of the country’s most vulnerable people who rely on free healthcare that does not deliver. Each day we hear reports of collapse, pain, indignity, loss, shock and grief. Our peoples’ Constitutional right to healthcare is being violated. We have received numerous complaints and reports of systems failure which has dire consequences for patients.
The Treatment Action Campaign (TAC) has been working in Limpopo since early 2000s 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 two districts in the province, Mopani and Vhembe. 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.
Our own monitoring in recent months at facilities across the Mopani and Vhembe districts confirm the extent of the provincial health crisis. In Limpopo, each TAC branch 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 to date can be found 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 OHSC1. According to the OHSC report, facilities should score at least 80% to claim an acceptable level of care – yet in Limpopo of 59 clinics inspected by the OHSC (not necessarily the same facilities as monitored by TAC) only 3% of the clinics are performing at 50% or above and none above 60%.
In November 2017, TAC Limpopo marched to the provincial Department of Health in Polokwane to raise our deep concerns over the dysfunction in the health system that is claiming lives, leading to widespread suffering, and means the dignity of poor people is being trampled upon every day. A memorandum was issued to MEC Phophi Ramathuba, yet to date we still await a written response on our demands.
While we initially welcomed the appointment of MEC Ramathuba – especially for her open approach and serious engagement with activists – more recently, her empty promises and foot dragging make it seem as if she is becoming indifferent to the suffering of poor people.
This report reiterates our concerns and outlines a set of detailed demands. The MEC of Health, Premier and provincial health department must take this seriously. If the MEC does not take our demands seriously, we will be back to the provincial Department of Health in our numbers. The province has a long way to go and it is critical for all parties to work together to improve the situation. It is time for the Department of Health to deliver on its Constitutional mandate, or face the consequences.
For more information contact:
Provincial Chairperson | Helen Nkuna | firstname.lastname@example.org | 071 836 1671
Provincial Manager | Moses Makhomisani | email@example.com | 073 187 0813
(National media enquiries |Lotti Rutter | firstname.lastname@example.org | 081 818 8493)