Decentralise decision-making and improve health care delivery

James Masango MPL

Provincial Chief Whip of the Official Opposition

Note: The following address was made by James Masango to the Mpumalanga Provincial Legislature during the Policy and Budget debate of the Department of Health.

Honourable Speaker, last year during the 2012/13 Department of Health’s policy and budget debate I stood here and spoke at length about the unacceptably high vacancy rate among doctors, nurses and other medical staff, the department’s failure to retain critical personnel, regular shortages of critical medication, and of course its failure to spend on infrastructure and revitalisation for two consecutive financial years.

Honourable Speaker, unfortunately nothing has changed, and in many instances the situation worsened. This year the premier and the MEC again promised that funds would be set aside to appoint medical professionals – yet the vacancy rate is still at 76% for medical doctors and over 50% for nurses.

If the MEC and the department are serious about appointing staff then they must do so with determination and commitment, to both increase the number of doctors and nurses in our health care system as well as to retain those we already have.

The same goes for the state of Mpumalanga’s hospitals. Every year hundreds of millions are made available for hospital revitalisation and infrastructure, but somehow, conditions don’t improve. Rob Ferreira has potholes in casualty, in Bernice Samuels the roofs are leaking and patients lie in the passages due to a shortage of beds, Tintswalo is still dilapidated, while Mapulaneng and Themba don’t have enough water or sanitation facilities.

Honourable Speaker, late last year the premier visited hospitals across the province and promised that action would be taken, and that health care would improve – yet, we still don’t see an improvement. The Human Rights Commission is currently investigating the state of our hospitals and health care in the province, and still the department is slow to respond.

  • Every year 422 new-born babies die in our hospitals;
  • 196 women die annually due to complications while giving birth;
  • We have 58 community healthcare clinics (CHCs), of which 21 are not able to provide any maternity services due to a shortage of staff, leaving an estimated R1,9 million worth of medical equipment to stand idle; and
  • The number of reported TB cases for Mpumalanga have increased from 23 312 to 24 451 in a space of only one year.

This while a world-class service exists in the private sector, but its costs put it beyond the reach of 88% of Mpumalanga’s residents.

Honourable Speaker, the basic health care system in Mpumalanga needs to be streamlined and overhauled to bring effective health care delivery to more than three million people who cannot afford private health care.

We have to explore options such as bringing private, public, community and NGO health care providers, who currently operate on separate and sometimes conflicting tracks, together in a comprehensive health care system, making it more efficient and more responsive to the needs of the people.

We have to decentralise hospitals and clinics, giving CEOs and CFOs the authority to set their own rates for patients with incomes above a certain prescribed level, appoint staff, collect fees, and respond to the health needs of the area they serve in the way that they see as most appropriate, within an overall national framework.

This would almost immediately improve service delivery as decision-makers would be held more accountable. Honourable MEC, why does the department employ Chief Financial Officers in provincial hospitals if they are not allowed to decide how their budgets are spent?

Hospitals must be allowed to attract as many fee-paying patients as they wish, and employ more staff and upgrade their facilities if they are able to generate the means to do so.

Decentralisation would reduce the department to a facilitating body where it monitors and oversees the overall effectiveness and smooth coordination of the health system, and ensure that the basic requirements for an effective health system are in place.

A system such as this would not only reduce the bloated bureaucracy and its massive annual salary bill, but also make more funds available for the operational management of health facilities.

If the state does not undertake health care service delivery with the necessary rigour and sophistication, the lesson from history is that health care become and expensive service accessible only by the elite – or no functional health service at all.

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