The BEMF is deeply concerned by the deepening crisis in the Eastern Cape health system and calls for urgent action to be taken
The 9th meeting of the Budget and Expenditure Monitoring Forum (participants listed in footnote) took place in Khayelitsha Cape Town on 4 and 5 July 2012. The purpose of the meeting was to discuss the deepening crisis in the Health System in the Eastern Cape and to identify ways in which civil society could continue to apply pressure on the government to take decisive steps in preventing its collapse.
The meeting identified several key issues that need the urgent attention of both national and provincial government. These issues include:
The provincial Department of Health and Treasury must make the details of their turn-around strategy public
The National Department of Health and Treasury must make public what their interventions in the functioning of the provincial department involves
Handing over responsibility for Eastern Cape Department of Health (ECDoH) core functions, such as Human Resource (HR) management is not sufficient or even desirable and a more comprehensive and far reaching intervention that includes all role-players must be developed and made public
Any strategy or austerity measures that are implemented must not result in the withdrawal of essential services such as the provision of basic medicines
The filling of vacant funded posts and the finalisation of the employment of health care personnel already providing services despite not receiving compensation for several months
The ECDoH should not continue with its threatened disciplinary action against Doctors at the PE Hospital Complex who held a press conference at the end of June highlighting their concerns around the imminent collapse of service delivery at their facilities. We maintain that these doctors were acting inaccordance with their ethical obligations to their patients.
The forum and its members have committed to supporting these doctors with any action necessary to ensure that they are not sanctioned for their commitment to service delivery
Members of theforum have been actively monitoring the situation in the Eastern Cape sinceearly last year and have noted the continued decline of service provision in the province. Most recently the forum and its members have called for the National Department of Health (NDoH) and Treasury to intervene in the crisis. On 15 May 2012 SECTION27 made a public call for the NDoH to intervene in the province based on clear evidence both within the budget and from healthcareworkers working in the public sector that the provincial department was on the verge of collapse.
This public call was followed by a letter to the National Ministers of Health and Finance urging them to develop and implement a turn-around plan that would ensure that in the short-term basic services would not interrupted and in the long-term steps would be taken to rectify the many failings in the health system and its administration which continue to contribute to the violation of the right to health in the province.In this letter the forum highlighted a number of issues that require urgent attention. These include,
The non-payment of health care professionals in critical posts
The moratorium on filling posts despite high vacancy rates in posts for critical staff including nurses and doctors
Continued stock-outs of basic medicines and medical supplies due to inadequate supply chain management and an inability to pay suppliers and service providers
Poorly maintained and inadequate infrastructure and equipment, including a severe shortage of accommodation for health care workers in rural areas
A growing budget deficit driven by snowballing accruals and an improperly managed turn-around strategy
An administration which is largely non-responsive and unaccountable
Endemic financial mismanagement, fraud and corruption
Both Ministers acknowledged receipt of the correspondence and there have been signs that action was being taken. On 22 June 2012 the Eastern Cape Health MEC, Sicelo Gqobana, announced that the Provincial Treasury would be taking over responsibility for human resource and supply chain management. While we believe that this at least demonstrates that the government acknowledges the crisis we do not believe this action is sufficient or evenappropriate in resolving the crisis in the province.
We believe that these issues taken together are beyond the scope and capacity of the provincial department of health and treasury to deal with alone. In fact, we received reports from doctors working in the province that since treasury has taken control of human resource functions, it has become impossible to fill funded posts that have become vacant and even to finalise the appointment of doctors who are already providing a service to communities in the poorest regions of the rural Eastern Cape. We have, for example, heard of one doctor from the United Kingdom who travelled to the Eastern Cape at the beginning of the year at his own expense to take-up a contract offered to him who despite rendering a critical service has yet to have his appointment finalised and be paid for his work.
Beyond provincial treasury taking control of several of the department’s functions it is impossible to say what else is being done to overcome the crisis. A detailed plan of action and intervention strategy has not been made public and it is not clear how or if the NDoH and National Treasury are involved.
The forum therefore calls on the National DoH, National Treasury and their provincialpolitical and administrative counterparts to make public the details of their interventions and turn-around strategies. This must include the details of all austerity measures and the impact these measures will have on service delivery and importantly the filling of vacant posts.
In support of the doctors in Port Elizabeth
The crisis has become so severe that the Heads of Units at the Port Elizabeth Hospital Complex took an unprecedented step of holding a press conference to make public thefact that should urgent action not be taken to rescue the provincial healthsystem, they would not be able to provide even the most basic services at their facilities by the middle of July.
We know that this decision was not taken lightly and was a last ditch attempt to force the department to respond to their continued pleas for action. In response the department has simply threatened to institute disciplinary action against the doctors involved.
The department has argued that the doctors have acted against the integrity of the department and in contravention of their contractual agreements with it. We are of theview, however, that had the doctors not taken this action they would be acting contrary to their ethical obligations to their patients, which undoubtedly supersede any loyalty to the department.
The forum wishes to make it clear that it is fully behind the doctors who face disciplinary action and will provide any support it can should the department take any action that would further jeopardise their ability to deliver care to theirpatients. We will not stand-by while doctors who act in accordance with their ethical obligations are punished for speaking out against the failings of the provincial health system and its administration, especially given that the Protected Disclosures Act encourages whistleblowers to come forward and protects such persons from any occupational detriment flowing from having made a protected disclosure.
Urgent intervention is still required
This crisis was foreseeable and therefore to some extent, preventable. We are concerned by the fact that efforts to turn around the department’s crisis have not had their desired effect and that the situation is growing in magnitude and severity, thereby having a significant impact on people’s health and right to quality healthcare.
Implementable and sustainable solutions need to be found urgently and made public. If the Eastern Cape Department is unable to immediately and effectively address these problems it becomes essential that the National Department of Health intervenes to maintain norms and standards in the province and prevent the drastic threats to health and health care that face many in the Province. It is particularly critical that any interventions, such as austerity measures do not deepen the crisis by leading to the withdrawal of essentialservices and the further deterioration of healthcare outcomes in the province.
Fundamental to this must be the appointment of doctors to all funded positions by ensuring that contracts are finalized.
For additional information or comment please contact the coordinator of the BEMF