SA healthcare system akin to Eskom – health ombudsman

PHOTO: Outgoing National Health Ombudsman, Prof Malegapuru William Makgoba

South African healthcare professionals have relinquished their power to politicians, resulting in a dysfunctional system epitomised by the 144-death 2016 Life Esidimeni tragedy from which the Gauteng Health Department has neither recovered nor improved.

That’s the opinion of outgoing National Health Ombudsman, Prof Malegapuru William Makgoba, whose seven-year tenure comes to an end next month, (May).

He puts abysmal public healthcare delivery in all but the Western Cape, Limpopo and KwaZulu Natal, (“where they have at least found a little direction,”), down to dismal provincial and hospital leadership, infrastructural decay, and an almost universal lack of human resource capacity.

“Because of understaffing at every level, you have little institutional knowledge about the disciplines being practiced in those hospitals. Everything has suffered and everyone is overworked and overstretched. Seniors become irritated with the human resource leadership and infrastructure of the hospital,” he adds.

He says Gauteng’s health department has been dysfunctional since 1 500 Esidimeni Life patients were decanted to cheap, mainly unlicensed, and grossly under-resourced care centres as a cost-cutting measure, resulting in 144 deaths, many of them from starvation and neglect. Advocate Dirk Groenewald, appearing for the grieving families at dispute resolution hearings in Parktown, Johannesburg in October 2017 called it ‘the greatest cause of human rights violations since the dawn of our democracy.”

When AxessHealth outlined Gauteng’s current grim tally of corruption, crumbling infrastructure, patient neglect, criminal syndicates, equipment failure, theft, arson, and organisational chaos, (alongside staff work overload), at tertiary level Makgoba said this.

“I first probed the Gauteng hospital health system via Esidimeni. There you see the crux of the dysfunction. It all revolves around that. Gauteng has been dysfunctional since then – and has never recovered. The administration has since had four MEC’s -compared to just one in Limpopo – that tells you something. The other part is in the Eastern Cape. I looked at Nelson Mandela Hospital, Livingstone, Dora Nginca – they’re all very dysfunctional and keep changing CEOs and administrators – not helped by their provincial health department. There’s no relationship between the healthcare professionals, the labour formations, and the department. Now they’re building a medical school in Nelson Mandela Bay and there’s no support for it, so you’re initiating a medical school amid a dysfunctional health service. These dysfunctional hospitals will serve as training hospitals for the new medical school. How do you navigate that?” he asked.

Makgoba said that in his Rahima Moosa Hospital findings, he highlighted the suspensions of two CEOs, one at Tembisa Hospital and another at Kalafong Hospital, and three others who left, (one at Steve Biko Hospital, one at George Mukhare Hospital and the other at Baragwanath Hospital retiring).

“Then, when you look at the criteria for CEOs, it’s very low. Anybody can apply. If you don’t have CEOs who can run the hospitals, how do you expect a healthcare service to be delivered?”

After his probe of three Eastern Cape tertiary hospitals last year, he reported his findings to the Parliamentary Health Portfolio Committee which promptly conducted their own inspections and found the situation, “even worse than I described.”

Shocking PE intern probe

“So, what you’re finding out via the interns’ experience in the Port Elizabeth Hospital Complex must have some truth to it,” Makgoba added.

He was referring to a Juta Medbrief expose by this author showing dysfunctional administration, almost zero accountability and severely compromised care at Livingstone, Uitenhage, Dora Nginza and PE Provincial Hospitals – as experienced by interns 14 months into their two-year tenures.

The interns spoke of unavailable porters, having to wheel patients around, dysfunctional lifts, fighting over every-day basic essential medicines and equipment and patients crowded into ‘overflow’ rooms awaiting procedures, several spending many nights sleeping on chairs – or being sent home unattended to.

They said their seniors were so overworked and stressed that they had little time to teach them skills, oversee procedures or help them build confidence – the core purpose of their two-year tenure in HPCSA-accredited hospitals.

The interns are paid R43 000 per month, including ‘fixed overtime,” of between 60 and 80 hours per month, though many, mostly in the obs/gynae and paediatric departments, do 100 hours per month, resulting in less people on call.

While there are counselling facilities available for burnt-out or stressed doctors, they said the service is seldom used because any time booked off must be made up – and they use most of their off time to catch up on sleep.

Prof Magkgoba’s summation of the core reasons behind State hospital dysfunction was echoed by a former DG of the Eastern Cape Health Department, Dr Siva Pillay, who said of the PE hospital complex; there’s no effective management. Unions rule the roost. When they can frog march CEOs and clinical managers out of hospitals and the court orders their reinstatement – but the health MEC is unwilling to enforce it, then nobody’s going to tell the nurses what to do. They don’t want to anger the unions.”

Pillay believes one of the root causes of the current PE Hospital Complex dysfunction can be traced back to the ‘eviction’ of the Livingstone Hospital and PE Hospital Complex CEO, Thulane Madonsela and his senior leadership by striking NEHAWU members five years ago. Madonsela and his senior colleagues obtained a court interdict allowing them to return to work, but the province’s political leadership failed to back them, and they subsequently resigned. It took several years to find somebody willing to replace them, so reluctant were candidates to take up the ‘hot seat.”

Said Pillay, “this is why you don’t get people dedicated and taking an interest in management positions – they don’t want a target on their backs. So, you get all the ‘yes’ people applying, with no interest in changing the status quo.”

Makgoba was asked by AxessHealth how he’d begin fixing the system.

“Let’s assume I was Minister of Health. I’d call all the MECs and CEOs of the hospitals and say we have a new country that’s going to be underpinned by a good quality health service. We’ve inherited a divided system. All we’ve done is insert ourselves into a system where the superstructure is still the old one. There’s no common vision, nothing to bind people together, to take the health system from Point A to Point B. Let’s use the budget in the best way we can to underpin what we want to do, rather than this Verwoerdian system still being used. We need a central, common vision, a baseline, norms, and standards of what to do. That’s missing. It’s not about a shortage of money – it’s how we use it!” he said.

Healthcare system and Eskom – shared lessons

Asked if he could pinpoint any single element, which, if changed would bring about the greatest change, he answered, “political leadership. The politicians have messed up everything – we’ve handed over our power as health professionals to politicians.”
Makgoba described Pillay’s observations about unions in the Eastern Cape as entirely reasonable and fair.

“It happens in education, in everything. We’ve handed over our knowledge and expertise to politicians. It’s exactly what happened at Eskom – the health system should have more conversations with Eskom than anyone else. They could learn lessons from one another.”

Asked if his seven-year stint as ombudsman had left him disillusioned, Makgoba said he’d “actually been listened to – a lot of people have listened. I appreciate that and I think it makes a difference. People have been compensated (as in Life Esidimeni), and there has been consequence management. With every probe I was clear about the consequences. I’ve spelt it out. If I go into a hospital where a patient dies of say, hypoglycaemia, and the doctor blames the system, I say no. In most places the things that cause damage to people are common sense. Because the system is so bad, everybody hides behind the system. I try and bring the level of responsibility closer to the person involved.”

Makgoba said it was not up to him to find political solutions.

He applied, ‘either medical or scientific solutions.’