DA Budget Debate on Health

Harold McGluwa, MPL

DA Provincial Chairperson 

Note: The following is an extract from the speech delivered in the Northern Cape Provincial Legislature today by the DA’s Provincial Chairperson, Harold McGluwa, during the Budget Debate of the Department of Health.

It is important for the provincial government to attend to the health of its people, as its people are the tools for the provincial growth and success. According to the department’s own information, only 18,9% of people residing in the Northern Cape have some form of medical aid coverage. This means that the majority of people in this province still rely on public health facilities and that great pressure continues to be exerted on state resources to provide health care services.

Doctors, nurses and other health professionals are the most critical human resources in the health care chain and an ample human resource component of high skill levels, is therefore the most important element towards effectively handling this pressure.  As a result, the DA has been calling for a proper recruitment and retention strategy to combat the shortage of health professionals, for years already. But the department has been slow to heed this call. In effect, many facilities have been operating without sufficient doctors and nurses. This can be seen in that the department still needs at least 93 medical officers, 326 professional nurses, 8 medical specialists, 47 pharmacists, plus a number of other health personnel categories across the province.

The new recruitment strategy, which has now been introduced to attract scarce and critical skills to the rural areas, is welcomed but is very long overdue. Changes to the recruitment policy need to be made with urgency to ensure that the absorption process of bursary graduates and community service doctors, is streamlined, so that we do not lose more talent to other provinces.

We are also concerned that little is said with regards to the retention of health professionals. Training them is one thing, but if we can’t keep them in the Northern Cape in the long term, then it defeats the purpose.

Rural healthcare workers often feel isolated, both from a professional and personal point of view. Support is therefore a crucial measure to retain more healthcare professionals in rural and underserved areas. A study of South African doctors listed better accommodation as one of the three most important factors that would influence them to remain in a rural area. Hence a good and safe working environment should be provided, which includes appropriate equipment and supplies, and supportive supervision and mentoring. The World Health Organization also suggests that living conditions for health workers should be improved and that investments in infrastructure and services, including sanitation, electricity, telecommunications and schools, should be made as these issues have a significant influence on a health worker’s decision to locate to and remain in rural areas.

The solution necessitates a whole-of-society approach, and calls for collaboration with other departments.

Unfortunately, however, it is in the line of partnering with other departments, where Health has fallen short in the past. We just have to look at the poor communication between Health and Public Works on the mental health front, to see this.

Due to ongoing bungles with regards to the mental hospital, a large number of people suffering from mental illnesses, as well as state patients who are languishing in prison, are still waiting for humane mental health care, despite this department already having spent R1,1 billion and counting on this state of the art facility. There are currently only 97 psychiatric hospital beds in the province and out of the entire province, only the Frances Baard district is currently able to provide 72 hour psychiatric services.

It is the past, present and especially future management of infrastructure by this department that deeply concerns us. For the 2015/2016 financial year, this department will receive no allocation in respect of the Health Facility Revitalization Grant as the result of non-compliance by the department in terms of Government Infrastructure Asset Management Act. It is unfair to the people of this province that a massive failure on the part of the Northern Cape Department of Health, has severely jeopardised the future of health facilities in this province. This is because the health department now stands a very possible likelihood of losing out on funds previously intended for the Northern Cape, which have now been placed in a pool and will go to the best bidder.

Public health infrastructure is fundamental to the provision and execution of public health services at all levels, and should include up to date data and information systems. The proportion of health facilities currently connected to the internet is therefore worrying. For this year, the department’s target is plans to connect the 11 District Hospitals and 33 Community Health Centres to the internet but what about the 130 clinics? Why should they have to remain in the Dark Ages. The department’s low level of information and communication technology infrastructure is negatively impacting on the ordering of pharmaceuticals, general operations administration and financial issues, such as the payment of suppliers.

It is thus no wonder that the Health Department remains the main culprit when it comes to not paying service providers within the prescribed 30-day timeframe.

Health’s financial state may finally have improved from a disclaimer to a qualified report, but this department still has a lot of work to do if it is serious about getting a clean audit.  It also still has long way to go it wants to transform mediocrity into excellence:

  • There is no growth in respect of the target for the number of ambulances operating with a two crew system, which in effect will see 40% of ambulances in the province operating with a single crew over the entire MTEF.
  • Only 40 in the entire province people will receive hip and knee replacement surgery during the course of the year.
  • Only 90% of eligible sexual assault cases receive PEP within 72 hours and by the end of this year, there will only be 40
  • And the Nurse Training College lacks the necessary skills to develop the curriculum and it still doesn’t have a simulation laboratory, despite its intake of 200 students training to become auxiliary nurses.

Better health governance is most meaningful to the most poor and marginalised, who are not covered by medical aids and lack the resources to access private health care. Like the rest of us, they deserve the best.

We are therefore pleased to see that within the next five years, this department intends on copycatting the Western Cape’s initiative of introducing technology and systems that will allow patients to collect medicines from any accredited pharmacy, making collection more convenient and less time consuming.

This is an important step in the right direction because good healthcare outcomes require many actors to ‘play the game’, including all departments, hospitals, clinics, the private sector, education institutions and civil society.

But this alone is not enough.

Instead, the solution lies in getting the provincial health department working adequately, and then instituting better planning, better budgeting and better allocation of finances for medicines, equipment, staff and infrastructure. This will go a long way in making the Northern Cape healthy so that our people can use their talents, follow their dreams and care for their families.

In closing, I want to remind this august House of the words of our beloved former president Nelson Mandela who said, and I quote, that “it always seems impossible until it is done” (end quote). For more than ten years, the department of Health was receiving disclaimer audits until it moved to a qualified audit in 2012/13. It seemed impossible that there could be an improvement from the mess the department was in and yet it happened. Let this encourage the department to continue working for the improvements that seem impossible until it is achieved.