Health Systems

Mpumalanga: state of health

– Mpumalanga state of health report published

Mpumalanga’s ailing healthcare system is plagued with serious issues. You wait hours to see a doctor, even in emergencies. Overstretched nurses take out their frustrations on the patients waiting for services. Facilities have not been properly maintained, and face shortages of supplies or medicines even for basic procedures. Ambulances take hours to arrive, or never arrive at all. Poverty and a lack of opportunity are widespread in the province. Almost a quarter of households survive without any income at all. Mining is growing in the province, giving rise to increasing rates of tuberculosis. In Mpumalanga, many vulnerable people rely on free public healthcare, but the reality is that the health system is failing them.

The Treatment Action Campaign (TAC) has been working in Mpumalanga since the 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 all districts in the province – Ehlanzeni, Gert Sibande and Nkangala. 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.

In 2011, the Gert Sibande District in Mpumalanga was put forward as an NHI pilot district. It was envisaged that the NHI piloting would revive the broken healthcare system in the district that was marred by medicine stockouts, inadequate infrastructure and a shortage of human resources. We hoped that the primary healthcare system would undergo a complete overhaul.

In 2013, TAC and SECTION27 started monitoring the implementation of the NHI programme in the district, by visiting various healthcare facilities across the district and speaking to healthcare practitioners and patients to get a sense of what the new NHI policy meant for ordinary citizens on the ground. It was clear that the piloting process had shown very limited success, although there have been some improvements in infrastructure at so called “ideal clinics” – however until now, the infrastructural, human resources and governance weaknesses in the district are far from resolved. It is clear that much more needs to be done to ensure that people can access to quality healthcare.

In Mpumalanga, 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 is 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 Mpumalanga of 57 clinics inspected by the OHSC (not necessarily the same facilities as monitored by TAC) only 14% of the clinics are performing at 60% or above, only 2% above 70% and none above 80%.

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. We also conduct ongoing investigations into the state of a number of hospitals in the province.

Overall, the severe challenges outlined in this report result in people dependent on the public healthcare system receiving inadequate and poor-quality healthcare services. These challenges also directly impact the success of the HIV and TB response in the province.

It is also evident that less and less people – whether health workers or patients – are willing to speak out and take a stand as they fear for their safety, the security of their jobs, or their access to health services.

TAC Mpumalanga demands provincial leadership and accountability in order to develop a turnaround strategy to address the crisis in the province’s broken public health system. This report outlines a set of detailed concerns and demands. We urge the MEC of Health Gillion Mashego, Premier Refilwe Mtshweni and provincial Department of Health to deliver on your Constitutional mandate and to urgently address these issues with the seriousness they deserve.




For more information contact:

Provincial Chairperson | Nqobile Shabalala | | 071 886 7735

Provincial Manager | Bellinda Setshogelo | | 082 622 4481

(National media enquiries |Lotti Rutter | | 081 818 8493)