Makhosazana Mdlalose, MPP
DA KZN Spokesperson on Health
The provincial health budget before us today cannot be supported by the Democratic Alliance. To know where we are going, from both a policy and budget allocation perspective, we need to take stock of where we have been and what the Department of Health’s achievements, or lack thereof, were during the past financial year.
Departmental performance this past year saw;
- Over-expenditure of R122 million or 0.49% of the allocated budget for the year 2011/12
- Unwarranted delays in the implementation of training programmes for dietician nutrition advisors, data capturers
- Never-ending infrastructure and maintenance backlogs which have impeded the proper implementation of the National Health Insurance (NHI)
- Continued under spending of donor funds while hospitals in this province are facing budget shortfalls and threats of closure and subsidy cuts by the MEC
- Strikes by Emergency Retrieval Services (EMRS) employees and the current strike/go-slow threats from trade union, National Education, Health and Allied Workers’ Union (Nehawu)
- Under expenditure of almost R30 million out of the R33 million allocated for the implementation of the NHI system in KwaZulu-Natal
- Stalling of infrastructure projects, especially the construction of Dr Pixley ka Seme and Dr John Dube hospitals.
Fiscal and Economic Management of the Department
The department, under the guidance of the Honourable MEC, Sibongseni Dhlomo and Head of Department, Sibongile Zungu, has also failed miserably in bringing any semblance of fiscal and economic management best practices. It is the DA’s belief that the audit qualification received in 2011/12 will continue to hang over this department for some time, despite naively optimistic plans to achieve a clean audit by 2014.
This department’s fiscal and management woes go beyond just asset register and expenditure violations pointed out by the Auditor-General’s Office. The DOH does not have a culture of, or one capable of fiscal and economic management best practices. This is brought about, in part, by the manner in which the MEC has personalised the department, making it his own fiefdom – the widely reported use of the department’s EMRS helicopter in the latter half of 2012 is just one example.
The disdain by which the Honourable MEC treats some members of this house has trickled down to officials within his department. As the DA’s representative on the Health Portfolio Committee and a Public Representative, I have on numerous times encountered rude, unprofessional and uncooperative departmental officials during oversight visits to various healthcare institutions in the province. These officials take their cue from the MEC – why else would they behave in this manner if they had the MEC’s approval, tacit or otherwise?
I would like to highlight some of the incidents that illustrate absolute mismanagement by this department, further evidence that the MEC is not fit for purpose and should do both this House and the KZN public a favour, and resign.
Recent incidents of poor management under this MEC include:
- The attempt by this department to withdraw subsidies to both McCord and Pongola hospitals, despite these hospitals servicing thousands of people that cannot be accommodated by an already burdened public healthcare system. The bellicose language used by the MEC and his department regarding the funding of the aforementioned hospitals should also be rebuked by this House. Indeed, some hospitals trace their beginnings to apartheid and at the time served mostly white patients, but they now serve all South Africans and the department should not use funding as a way to punish hospitals and residents of this province
- Recently on May 21, the Democratic Alliance made it public that patients at St Margaret’s hospital in Umzimkhulu went for almost three weeks without food; this after the department reportedly defaulted on its payment to PCK Distributors. This incident is only the tip of the iceberg; the department under this MEC continues to violate treasury regulations on procurement, by consistently procuring goods and services without inviting competitive bids and dealing with companies prohibited by the National Treasury from doing business with the public sector
- Violating Treasury regulations is symptomatic of many transactions and actions taken by this department and the latest announcement on radiotherapy machines at Addington hospital serves as the most recent example. After months of withholding payments to Tecmed Africa and machines lying gathering dust, the department decided to resume payments without any meaningful explanation. While the DA welcomes the machines being switched on, we still want to know – why were they switched off in the first place? Why is the contract being revisited when the department agreed to it at the outset?
The DA puts to this House that continuing to distribute funds under this MEC, under such poor management, under such disorderly conduct, is risky business. The KwaZulu-Natal Department of Health is ailing – in fact it is in ICU!
We implore the ANC government in this province to strengthen the fiscal and economic management capacity of this department so that people of KwaZulu-Natal province can finally receive optimal health services.
National Health Insurance (NHI)
It is time for the ANC government to concede that NHI is a disaster. There is no money to fund this expensive and misguided experiment. The NHI grant has decreased, significantly, and the province has very little say on how the National Department of Health will disburse these funds. Also, the decision by the National Department of Health not to increase the number of pilot sites in 2013/14 is telling of the failure of the NHI system.
The system, as piloted in KwaZulu-Natal has been preposterous. Out of an allocation of R33 million, the province has only spent R1.174 million. Funds allocated for the implementation of the NHI system in UMzinyathi have not been spent and reportedly delayed by supply chain obstacles. The same state-of-affairs exists in UMgungundlovu, which has thus far spent only R932, 000 out of the R9.7 million allocated.
Again, this speaks to poor fiscal and economic management within the department. When will this government realise that the problem is one of poor governance, something which the ANC government is incapable of.
Even if NHI were the proper course to take, how are we to implement it if nurses, doctors and administrators have not been trained on this new system? Adequate training and orientation on the NHI system has been lacking in both UMgungundlovu and UMzinyathi.
The difficultly with South Africa’s health system was never about financing or the ability to pay, as per the rationale of NHI system. The problem with KwaZulu-Natal’s and South Africa’s healthcare system is a lack of accountability, ineffective monitoring and evaluation, poor management, lack of implementation of existing policies, over-centralisation and corruption. Experimenting with discarded first world systems, such as NHI, without addressing the aforementioned problems, is a wasted exercise. The NHI system, from a healthcare standpoint, also fails to understand that health is a lifestyle choice – “health is more than just a bottle of pills or a bag of herbs”.
In conclusion I would like to reiterate that the Democratic Alliance cannot support this budget vote for the reasons just explained.