Speech by DA’s Shadow Minister of Health, Dr Wilmot James MP, during the budget vote debate on Health, parliament, May 5 2015.
Appalling conditions at hospitals cripple the ideals of good quality health care
Honourable Speaker,
Provinces account for 90% of total public health spending. According to the Financial and Fiscal Commission’s submission on the 2015/16 Division of Revenue Bill, ‘Health Budgets will increase significantly when the proposed National Health Insurance is introduced and thus, unless the inefficiency issues are addressed, the problems will continue.’
In last year’s budget address I highlighted the poor audit outcomes (2012/13) for each provincial department. Well, there has been no significant improvement.
Limpopo: Improvement from disclaimer with findings to qualified.
Free State: Stagnated on qualified with findings.
Eastern Cape: Stagnated on qualified.
Northern Cape: Stagnated on qualified with findings.
Mpumalanga: Stagnated on qualified with findings.
KwaZulu-Natal: Stagnated on qualified with findings.
Gauteng: Stagnated on qualified with findings.
North West: Unqualified (same as previous year).
Western Cape: Unqualified (again).
The identified root causes are:
1. A lack of consequences for poor performance and transgressions;
2. Slow response by political leadership; and
3. Key officials’ inappropriate competencies and vacancies or instability in key positions
Increased funding for the Office of Health Standards Compliance is welcomed. According to Treasury the focus over the medium term will be on accelerating the office’s performance.
Funded through transfers from the Department, R85.2 million has been reprioritised over the medium term. Transfers received are expected to grow rapidly over the medium term, at an average of 17,8 percent per year.
Honourable Speaker, the Democratic Alliance visited the following hospitals in the past few months of this year:
Grootte Schuur (Western Cape), Livingstone (Eastern Cape), Albert Luthuli (Kwazulu-Natal), Pelanomi (Free State), Kuruman and Kimberley (Northern Cape), Klerksdorp-Tshepong (Northwest), Baragwanath and Tembisa (Gauteng), Rob Ferreira (Mpumalanga) and Polokwane (Limpopo).
What we found at these hospitals was shocking.
Reliable electricity supply is a serious risk at Baragwanath, Rob Ferreira and Pelanomi;
Staff shortages are causing unacceptably long queues at Pelanomi, Kuruman, Klerksdorp-Tshepong, Baragwanath and Rob Ferreira. It will become a problem at Tembisa once the innovative queue-shortening EPWP programme ends;
Infection control (especially for tuberculosis) is a risk at Livingstone;
The proper disposal of medical waste is a serious problem at Kuruman and Pelanomi. Tenders for the disposal of medical waste are a major opportunity for corruption and fraud. Minister Motsoaledi must investigate this and tackle the problem as a matter of urgency;
Stock-outs of key drugs are endemic to the Free State and Limpopo; and
Kuruman, Rob Ferreira and Pelanomi are in a chronic state of collapse.
The key problem at poor performing hospitals is the quality of CEOs. Just walk into Kimberley or Grootte Schuur hospitals to see what a difference good CEOs can make.
On 18 January 2013 Minister Motsoaledi announced the appointment of more than 100 new CEOs for public hospitals, fulfilling his promise to ensure these positions are filled by qualified people.
A review of hospital managers published in 2011 found that some CEOs were political appointees, with neither healthcare nor managerial qualifications. Some provincial health departments had appointed former teachers to run complex bodies with multimillion-rand budgets.
It does not seem as if Minister Motsoaledi’s 100 new CEO project had much effect. He should provide a full and comprehensive report to the Portfolio Committee on Health on how he is advancing the cause of appointing fit-for-purpose hospital CEOs.
The Department of Health is in its fourth year of the 15-year rollout of National Health Insurance – the government’s path to ‘universal, quality and affordable health care’. Pilot activities are currently under way in 11 districts.
The 2015 Health Budget states that plans are to release the NHI White Paper in early 2015. The answer to a parliamentary question of March 2015 stated that the NHI White Paper and related Finance Paper would be out before the end of December 2015.
We are a third of the way through the NHI roll out and we still do not know what the final policy is and how the government will finance it. This is a blank cheque in the midst of fiscal squeeze.
Pilot sites experience various difficulties. Due to poor working conditions, the programme failed to attract enough general practitioners, the consequence being that the conditional allocation has been reduced by R355.3 million to R884.17 million over the next MTEF period.
The NHI is a failing proposition. We should go back to the drawing board and design practical and workable social entreprise models to provide healthcare for poor South Africans, including the introduction of low-fee public-private clinics.
I thank you.
Issued by the DA, May 5 2015
