Memorandum: TAC demands duty bearers fix the Gauteng health system now!
Memorandum: TAC demands duty bearers fix the Gauteng health system now!
6 August 2021
The Gauteng Province healthcare system has been in alarming decline for a long time. As early as 2012, we, as the Treatment Action Campaign (TAC) penned a document titled “Monitoring our Health: An Analysis of the Breakdown of Health Care Services in Selective Gauteng Facilities” in collaboration with SECTION27. It is heartbreaking that the issues raised then as urgent are still as critical today, almost an entire decade later. These include, but are not limited to:
- Poor emergency medical services;
- Significant staff shortages;
- Corruption and lack of accountability;
- Inadequate budgeting;
- Financial mismanagement;
- Shortages and stockouts of medicines.
What alarms us more is the string of broken promises made by duty bearers about efforts taken to improve the healthcare system, with only lip service being paid to life and death situations. We list the issues below and our demands:
Charlotte Maxeke Academic Hospital
Charlotte Maxeke Academic Hospital has largely been closed since it burnt in April 2021. As a result, other hospitals across the province have been overburdened with patients. Worryingly, we saw inaction on the part of the state, in particular, the Premier, David Makhura, who failed to find a solution to the impasse even when the province’s health care sector was overburdened. While we welcome the opening of some units, such as radiology, some theatres, outpatient services and rather belatedly, the COVID unit, we note with concern that according to MEC Tasneem Motara, the areas adversely affected by the fire will only open as late as 2023, further hindering some patients’ right to health.
We demand that you prioritise fully opening Charlotte Maxeke Hospital and ensuring that patients get access to quality healthcare services! This will also help relieve other hospitals such as Chris Hani Baragwanath hospital. We note with grave concern that 118 doctors and 69 nurses are reported to have resigned from Bara Hospital in 2021 alone, further worsening the shortages of staff.
Wait times and unnecessary deaths
According to research collected by Ritshidze, one of the most extensive community-led monitoring projects in the world, between April to June 2021 patients waited an average of 4,38 hours in order to be seen at facility level in the province. Many clinics take much longer, with Tembisa Main Clinic averaging a waiting time of 8 hours 41 minutes. Multiple stories have emerged of patients dying while waiting to access care. Examples include Gogo Tsotetsi, who died last year while waiting for assistance at Phuthanong Clinic in Tsakane and Sichelesile Dube, who died while waiting for medical staff to attend to her at Helen Joseph Hospital last month. We note that these unnecessary deaths are very often followed by investigations that exonerate the Department. We demand solutions, not excuses!
In a similar vein, we call on duty bearers to ensure that the province’s incidence rates that lead to medico-legal claims are significantly reduced. Deaths such as that of Shonisani Lethole’s are unacceptable! We align ourselves to the #Justice4Shoni campaign’s ten key demands, including calling for:
- Disciplinary action be instituted against medical staff who failed in their responsibilities for Lethole’s care
- That President Cyril Ramaphosa, Gauteng Premier David Makhura and Gauteng MEC for Health Dr. Nomathemba Mokgethi publicly acknowledge the pain and suffering of other families who have had loved ones die at Tembisa Hospital in circumstances that need clarity and where they received substandard care
- Strengthening the board to improve the management and governance of the hospital.
Termination of Pregnancy and other SRH services
The Department of Health has over the years highlighted facilities that provide termination of pregnancy (ToP) services in the province. However, the TAC in Gauteng has started engaging in monitoring and we found out that the two on the list that we visited did not offer the services stipulated. We demand that the Department of Health ensure that ToP services are adequately available in order for women to be able to access affordable, safe and quality services.
The constitution guarantees access to sexual reproductive healthcare, but on the ground, people are oftentimes not able to access these services. In Gauteng, access to contraceptives is a problem. When you go to a clinic, it’s either you get the pill and not the injection, or you get IUD and not the pill, clients are often forced to use methods they do not prefer because of shortages and stockouts of contraceptives. We demand improvement in availability of contraceptives, so that patients can access all the types of contraceptives as listed in the department’s guidelines.
Life Esidimeni
Following the unnecessary tragedies that occurred in the province as a direct result of Qedani Mahlangu’s decisions, which cost the lives of at least 144 mental health care users (MCHUs) and negatively affected the lives of more than 1,400 more, many promises were made. Sadly, many of these have just been empty promises.
We call on the Premier and the MEC for Health to:
- Ensure that the decisions of the Life Esidimeni arbitration process are adhered to. As instructed by retired DCJ Moseneke in the Award, the provincial government was meant to enact a monument at its own cost within twelve months (June 2019) to the MCHUs. Three years later we sadly have not seen it. We demand that this memorialisation be completed as soon as possible.
- We demand to know the current number of MCHUs and their families that have been traced, how many have been remunerated and how many have not been. We would like an explicit commitment on when they will all be compensated, as this is long overdue.
We acknowledge the tireless efforts of organisations such as SADAG and SECTION27 in ensuring that justice is served in this regard.
The state of public healthcare facilities
We demand improvement in the physical infrastructure of clinics in the province. The condition of public clinics is unacceptable. Half of the clinics (4 out of 8) monitored by TAC branches in the Tshwane district in the past fortnight had no functioning toilets for patients. These facilities were dirty and they had no essential hygiene items like toilet paper, soap or sanitiser. In Ekurhuleni district, 6 of 10 facilities recently monitored had no functioning toilets for patients, and 3 clinics had no water access.
TAC also monitored 3 facilities in Sedibeng during this timeframe and the infrastructure and environment poses more serious health hazards, as the facilities in question have sewer leakages and no water due to old destroyed pipe systems. One facility still has pit toilets.
Another key challenge in Gauteng clinics is the space. 5 out of 10 recently visited clinics are very small, hence patients have to sit outside in the sun and rain. Clinics have been witnessed dispensing ARVs at the door in Tshwane and Ekurhuleni, posing serious violations of confidentiality, leading to an increase of patients defaulting on their treatment.
Several requests for expansion of clinics and construction of new structures have been submitted to the department but sadly nothing has been done. Instead, we witness looting of public funds while people suffer in the communities. In some areas like Khutsong in the Ekurhuleni district, construction of clinics began and stopped and nobody knows why.
We demand the department of health to escalate the process of construction of new clinics and expansion of existing clinics to better serve the people.
Corruption
Despite an SIU report highlighting over R1,2 Billion in corruption during Brian Hlongwa’s tenure as MEC for Health between 2007 and 2009, he still walks free, without seeing a day in court. To add insult to injury, the funds haven’t been fully recouped and most of the other actors held criminally liable. It is clear that the Department has been in dire straits since then. We call on the department to act in concert with law enforcement agencies to ensure that all offending parties are brought to book and this matter resolved.
These issues are sadly a tip of the iceberg that is the Gauteng health crisis. Fixing them, however, will go a long way to improving the state of healthcare in the province. We remain resolute in our commitment to working with the Premier’s Office, the Department of Health and many other stakeholders to improve the state of health care services in the province.
