Health microscope shows KZN failing to meet Millennium development goals

By Dr Imran Keeka, MPL, DA KZN Spokesperson on Health:

SEVERAL KZN districts are the worst performers in the country on a number of health indicators while the province is also lagging behind on United Nation’s Millennium Development Goals (MDG) 4 and 5 in particular.

KZN also has the highest HIV rate in the country, varying from 37.4% to just over 40% in some districts. Sadly, initiatives to mitigate the spread of this pandemic, such as MMC are sitting at less than half the target.  The unacceptable reasons for this must be repeated by the MEC for the benefit of the house.

Neonatal and under-5 death rates remain high, with a third of children who die in our facilities, dying of severe malnutrition.  This tells of possible failings of areas of operation Sukuma Sakhe and the socio-economic state of the province which, from the health telescope, is in a dire state.

The DA welcomes an improvement in the TB cure rate and the initiative to mass test for TB, which will hopefully be rolled out soon.  Key to prevention is early detection and the preventive medicine model is ideal even for NCD’s.

In the third quarter of last year in Utrecht there was an almost 400% increase in malnutrition reported.  In Umzinyathi we heard of a very high incidence of dehydration and diarrhoea because people   drink filthy water, especially children.

Where water purification tablets and bleach, may be occasionally available as cited during that visit, the South African developed miracle straw is looked at as a possible long term investment for these poverty stricken households. Once again, prevention is better than cure.

I should like to proffer some advice where attempts to prevent virulent outbreaks, such as with the recent deaths due to Diphtheria, that government stocks, even in limited quantities, the Antitoxin which may save lives.

NHI

Contrary to some claims, the white paper on NHI is nowhere near completion. The de facto position is that there is no indication that the process has even started.  And so there is no clear direction as to where it is heading.  How can it be that there is talk of this elaborate design but no blue print? So where does one begin – is taxpayers’ hard-earned money being dished out for a pie in the sky project?

All provinces receive an NHI grant.  KZN, unlike other provinces, has three pilot sites.  Unfortunately, KZN is also notorious for under-spending this money despite being guilty of overall over-expenditure on its budget.  This resulted in a first charge of R107 million over the 2015/16 MTEF and then R150million at the end of the last financial year.

On the subject of NHI, I should like to go back to the Premier’s speech of 27 February where he contends that all 85 hospitals and 119 clinics in pilot districts of Amajuba, Umzinyathi and Umgungundlovu are connected to telemedicine.

However plausible this may sound, I must disagree. Either someone has given him false information or he is shooting from the hip – hopefully not the latter.  Rule 241 (2) (g) must be invoked to determine where the MEC got this information from and why it was used to mislead this House.

Responses to DA Parliamentary questions, to which the MEC’s signature is appended, tell us that the ISDN services of 3 referral facilities were disconnected in February.  Furthermore, clinics visited either with the portfolio committee, or on my own, showed that this information is indeed false.  In fact, at one of those clinics, in an NHI pilot site, no one even knew what I was talking about.

I urge the Premier, to look into this so that the public is not lulled into believing certain things about NHI that will eventually lead to disappointment.

The alternate NHI model, tabled and implemented by the DA in the WC, is going to be a better option given the prevailing standards and model of healthcare.  I propose that this idea is pursued here in KZN because it shows how the objectives of the 2030 Vision can be achieved successfully.

The stock answer etched in the MEC’s psyche “that NHI will happen” is not enough and must be considered baseless.

Section 27 of the Republic’s constitution confirms the right to access healthcare freely for all – including emergency healthcare.  The MEC should therefore not entertain the notion that the DA, under any circumstance, will oppose equal access to any facility – we are firm constitutionalists.

In stark contrast,   the Quality of Life committee recently heard horror stories about the elderly being turned away from a healthcare facility in Newcastle and the indignity and humiliation caused by the state’s dereliction in ensuring their freedom to access care.

My remarks and examples are some of KZN’s contributions to this elaborate ‘castle in the air’ project, if ever it comes about.

The DA has a plan.  Not just a plan.  It is something already working and is not very dissimilar to the vision for Health 2030, and in that plan it sets aside the concept of NHI as mooted.   Chairperson, we must schedule a slot to further cross swords in this regard.  We are indeed in a race against time.

On the NHI grant -if we are properly using funds to build institutions, infrastructure and to improve the delivery of healthcare then good.

But to think that the infrastructure without the ingredients – without nurses and without doctors and without specialists – will get us anywhere, then it is imperative that the governing party rethinks this model.  This is common sense.

 

A sick department

I have no doubt, that when the MEC responds to this later, he will give us reasons for the huge vacancy rate in the province, about the exodus of nurses and the ongoing protest action arising from massive dissatisfaction of the employees in various fields.

We sit with an estimated 25% less doctors, 28% less specialists, and just over an average of 11.5% across nursing disciplines, not to mention pharmacists, dentists and the allied fields where figures are probably higher today.  This sample of figures is for targeted critical employment areas that KZN can currently afford, not what we actually need.

Risk assessment places this department in the category of “high risk”, exposing us to significant vulnerability including litigation. So of Contingent Liability, the massive medico-legal bill is sitting at over R3billion. What the MEC must tell us is, who will be paying the defence bill over and above the claim?

I ask this because this department is one of the largest spenders on consultants.  And we must know whether this medico-legal work will be the job of yet another consultant or handled in-house.

Our hospitals are also heavily burdened this year with no intake of interns from UKZN.  This translates to almost 300 less in the medical team and no intake of registrars yet again.  Meanwhile we are sending 10 students to Cuba this year.

While the department has given its reasons for not training registrars this year, a Specialist said many of his colleagues would love to work in the public arena if it were well-managed.

The precarious assurance by the then HoD that there will be an intake of registrars next year remains uncertain.

The backbone of the intended project of the health vision for 2030 does not lie in empty buildings or the filling of plush office-based-jobs which tick box the filling of an organogram.

It lies in a change of mind-set, away from the current to an integrated model involving the best of both the public and private sectors. Other than the cost factor, which can be negotiated, IALCH is a good example of how this can work.

The KZN Health department currently has an acting HoD and no CFO, with no intention to advertise this latter post in the immediate future.

Meanwhile, morticians are on a go slow and the EMRS are doing the same with recurring protest action. During the last portfolio committee meeting, the indignity and humiliation of people and disrespect of the deceased in Mortuaries were both highlighted.  Which we hope can easily be solved with screens.

 

Poor leadership

Qualified audit after qualified audit – with the Auditor-General citing stagnant leadership in his findings.  The National Planning Commission of 2012 gives several reasons which hold true even today

“The management of the health system is centralised and top-down. Poor authority, feeble accountability, the marginalisation of clinicians, and low staff morale are characteristics of the health system. Centralised control has not worked because health personnel lack discipline, perform inappropriate functions, are not held accountable, do not adhere to policy, and are inadequately overseen. In addition, the institutional links between the different levels of services are weak.”

The DA is satisfied that the recycled cadre, Mr Biyela, is not at work, is not getting paid and every effort will be made to ensure he does not return to KZN health.  We have still not received any explanation of how he was appointed.  We are of the view that this is worthy of further investigation and we must press on with it if a full and complete disclosure of the alleged illegal activity known to the MEC is not made public.

While EMRS response times should be quicker in urban areas, a man with a P1 emergency died recently because EMRS did not respond on time.

The MEC and his department must intervene in the matters of employees in the critical area.  The problems have persisted over a very long time.  As a result, more people are dying more often.

In dealing with response times and shortages, the MEC has announced the delivery of 60 new ambulances. This is most welcome.  What is Ironic is that they were kept until now, instead of being put to good use when they were procured some time ago.

We should not be playing politics in matters of life and death. I urge the MEC again to immediately resolve the issues of the personnel who will man these vehicles.

The MEC knows that KZN needs at least 5 times more ambulances than the projected procurement of 754 by 2019.  In another province where the healthcare budget is just over half of KZN’s: last year, 393 old ambulances were replaced.

If asked, the MEC cannot report on response times either.  In a response to parliamentary questions in the National Assembly, it was confirmed that there is no verifiable system in SA to determine this.  There are norms and standards yes, that tell us what these should be in different areas and then there is guess work.  So if he gives us the numbers, they are, at best, a thumb-suck.

The DA welcomes the initiative that will ensure the distribution of medicines to convenient places of collection, reducing queues at health facilities and fundamentally making life easier for so many.

In KZN people are starting to be registered onto programmes and we have begun dealing with the teething issues that are related.  In the Western Cape C, last year, the programme was completely rolled out, including the distribution of medicines using private pharmacies.  In addition, following my discussion with the former provincial health minister, a pilot project for door to door delivery was being tested, using the lessons learnt from other programmes such as MUMConnect.

Last year the MEC reported on mobile hospitals.  He must today tell this house about what seems to be an irregularly awarded tender.  One where vehicles will be leased out at an estimated cost of hundreds of millions of rand eventually and still won’t belong to the province.  Where are they?  We want to see them.  All four.

The MEC must also tell us why the case numbers related to fraud at Addington surrounding the cancer machines, are false and relate to incidents such as public urination and why no criminal charges were laid against those complicit in the crime.   Who are the individuals and why have they been let go scot-free?

If we were to ask the people of KZN or indeed many millions of people across the country what the ANC’s biggest crime is you may hear “Nkandla”. Here R240mil bought everything including the fire-pool amongst other instalments.

Yet here in our own backyard the KZN Health department has spent R229million on a laundry facility at one hospital – a figure which continues to rise.  Alarm bells should be ringing. The DA raised concern when the figure was sitting at R150million and counting.

Then there is the issue of another R50 million spent on a hospital laundry in Dundee?   We will be asking for these to be further investigated.

KZN’s contribution to strengthening our national healthcare system is disappointing, in fact could be amongst the weakest links.  The recent torch-light caesarean section delivery in Kokstad sums up so much if you think about it.