Crisis management at Chris Hani Baragwanath Hospital
Dr NANDI DILIZA: Yes, it’s a state of decay, really’¦ The hospital is vrot and it needs to be revitalised’¦
KHOPOTSO: Dr Nandi Diliza, Director of Hospital and Specialised Services in the provincial Department of Health, in Gauteng. The state of decay at Chris Hani Baragwanath Hospital is largely due to the following.
Dr NANDI DILIZA: We’ve actually identified four pillars that need attention. That’s general management, human resources, finance and the clinical side’¦
KHOPOTSO: These are the findings of an investigation initiated by health workers’ union NEHAWU, and conducted by labour research group NALEDI, four years ago in 2000, using the surgical unit as a case study. Andile Kolanisi, former NEHAWU co-ordinator in Gauteng, says the underlying concern at the hospital is its budget of R950 million per annum, which is considered too little for a hospital the size of Chris Hani Baragwanath.
ANDILE KOLANISI: That allocation does not take into account what they call ‘bed’ and ‘personnel’ expenditure. You’ve got more beds at Chris Hani Baragwanath compared to Jo’burg Gen. In terms of personnel also, you’ve got more personnel at Chris Hani Baragwanath compared to Jo’burg Gen. So, there is no equity in terms of distribution of the allocation of budget’¦ There is a 14% gap between what is offered at Chris Hani Baragwanath compared to Jo’burg Gen.
KHOPOTSO: Hospital management will have to do some work to address the imbalance. Nandi Diliza again, Gauteng Director of Hospital and Specialised Services.
Dr NANDI DILIZA: There’s an agreement that there is no equity if you look at Chris Hani Bara and Johannesburg Hospital, which is an institution at the same level ‘ we call them central hospitals. In order to get around that process we’ve asked them to start a zero-based budget or activity-based budget, where they don’t just take the previous year’s budget and add an inflation rate. We’ve said look at your activities, cost them and tell us what you need, and then as a province we’ll look into that and address equity.
KHOPOTSO: On the other hand Diliza’s department charges that it’s actually patients who over-burden the system.
Dr NANDI DILIZA: People don’t understand the issue of primary health care.
Somebody will have a toothache, somebody will have a rash, somebody will have an earache, and they will walk into Bara. And according to health economics as soon as you open the corridor of an institution the size of Bara and get a file, already R500 goes down’¦ So, we have to educate the public to the fact that Chris Hani Bara, Helen Joseph and Johannesburg Hospital are referral centres. People who go there should only be those who are referred by the clinics and also even private doctors. People shouldn’t just walk in for common colds or something like that because it is costing us.
KHOPOTSO: Crucial positions from management to nursing are vacant. The hospital is experiencing a 36% shortage of nurses. Better working conditions and pay in the private health sector and abroad have ensured that the recruitment pool of health personnel remains limited.
Dr DILIZA: We advertise posts, say, for 50 nurses. You get 20 responses. That’s the challenge facing us. There are no pharmacists in the country; your specialised nurses; your allied health professionals, that is, your physios, OTs, and so on.
KHOPOTSO: Staff discipline and a better work ethic is another aspect that the transformation programme at Chris Hani Baragwanath Hospital hopes to address. The other three unions ‘ DENOSA, HOSPERSA and NUPS ‘ have bought into the programme. Heather Mchunu is a NEHAWU shop-steward.
HEATHER MCHUNU: Some of our members were part of those problems’¦ We were having problems of people who don’t want to work, people who drink during working hours, people who are leaving the institution during working hours, theft was overwhelming.
KHOPOTSO: Since 2003 a new management structure was brought in to help save the hospital. Diliza believes that with the new management the goal to transform Chris Hani Baragwanath into a ‘People’s Hospital’ is possible.
Dr NANDI DILIZA: They would over-spend by over R100 million. I’m told this year that they are just about R30 ‘ R40 million over budget, which is really an indication that the current management is beginning to bear fruit. And it’s not that services have decreased. But they’ve just made sure that the sheets stay there, the paper stays there, the drugs stay there, they don’t disappear.
KHOPOTSO: Attempts to speak to management were not successful. Although hospital CEO Ella Bondarenko had approved an interview with the hospital’s Clinical Director Dr Arthur Manning, Dr Manning was too busy to talk to Health-e. Meanwhile, health union NEHAWU, welcomes the transformation plan ‘ a long-term process which is expected to start in July ‘ but it is concerned about the capacity of leadership. The current CEO is retired and has been called back as an interim measure.
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