Despite the decision to transfer over 2 500 health workers from Gauteng province to Johannesburg once it becomes a unicity, no formal agreement exists between the city’€™s management and the province on how this will happen.

“At present, discussions with the province are based on goodwill rather than a formal agreement,” said Dr Lahla Ngubeni, the project leader for local government health services.

“This is a matter of concern as we would like a formal and binding agreement from the MEC for Health.”

Ngubeni added that he expected the transfer of such a large number of staff to be “a long and difficult process”, but hoped that the province and the unions would both buy into the process.

However, National Education, Health and Allied Workers Union (Nehawu) spokesperson Moloantoa Molaba said his union “was not involved in discussions involving any transfer of health staff to the unicity”.

Both Molaba and SA Municipal Workers Union (Samwu) spokesperson Anna Weekes said their unions were not opposed to the transfer of staff to local government.

“Unions are in favour of the transfer of staff to the local level in the interests of better service delivery,” said Molaba. “But there will be a big fight if they want to privatise any services.”

A provincial task team is working on a memorandum of understanding to guide service delivery in the interim as well as the transfer of staff and primary healthcare services to local government, but this may only be ready at the beginning of next year.

However, Gauteng health department’€™s Dr Rafiq Bismilla said that by the time the new unicity council comes into office after the local election, “we should be able to indicate to them what services have been devolved to them”.

But “intense negotiations” between the Health MEC and each of the six councils to be set up in Gauteng on how health services and staff would be transferred “will only start next year”, Bismilla said.

It was likely that the transfer of services and staff would be phased in, “based on the capacity of local government”, he added.

Complicated human resource issues such as leave, pension funds and conditions of service would need to be agreed on before staff transfers took place, he added.

Ngubeni said that, at the earliest, all health staff would be transferred by June next year.

He added that the task team needed to identify the core activities performed by provincial and local authorities and look into outsourcing “non-core” activities, such as ambulance services, security and maintenance.

However, he stressed that outsourcing did not necessarily mean privatisation, but could mean that other council departments could take over performing these functions.

Ngubeni said his main concern was to ensure that public healthcare in Johannesburg was improved as the “haemorrhaging of nurses from the public health service” had led to a deterioration of services.

“In 1994, 950 000 patients attending primary health clinics in Soweto were seen by 800 nurses. Today, there are about two million patients and only 500 nurses,” said Ngubeni. “We need to be more patient-focused. Given the HIV/AIDS pandemic, we need the structures to deal with this.”