Poor patients ‘excluded’ from healthcare by high transport costs
In preparation for the public hearings, which begin in Johannesburg today (30 May), the SAHRC visited 91 health institutions countrywide, including 57 hospitals.
What emerged was a ‘leadership vacuum’ in which ‘things happen but nobody cares or hears’, reported the SAHRC.
One of the key findings of the nine-province review is that the poorest patients are effectively being excluded from healthcare as they can’t afford to pay for transport.
At the same time, ambulance services are ‘at best inadequate and at worst non-existent’.
In Mpumalanga, poor roads and long distances pushed up the price of fares to hospitals to around R90 while in the vast Northern Cape, patients had to pay up to R500 to get to a hospital.
In KwaZulu-Natal, patients needing more specialised tertiary level care could pay as much as R400 for transport, while in the Eastern Cape, the lack of public transport as well as cost, hinders access.
While the Constitution states that ‘no-one may be refused emergency medical treatment’, the review questions whether this has any meaning when there are no ambulances to take patients to get treatment
‘In some cases, ambulances arrived after five or six hours or even the following day, when the patient had already died,’ notes the review.
Massive staff shortages, especially of nurses, also featured prominently in the review. ‘The shortage of staff in the health system is creating a vicious cycle leading to extremely stressful working conditions as well as unduly high workloads for those remaining, resulting in further staff leaving,’ notes the review.
A new hospital in Calvinia with modern equipment ‘had not been able to perform any operation, not even the removal of tonsils, due to unavailability of qualified nurses to assist at theatre,’ observes the review.
Poor pay and working conditions were causing staff to leave, according to those who spoke to the SAHRC staff.
‘There is a general feeling among health workers that staff, especially nursing staff, are underpaid and overworked.
‘There is a strong sense that more needs to be done by the Department of Health to attract nurses to fill vacancies, and to retain them by offering better remuneration packages, incentives and career advancement opportunities, as well as improved working conditions.’
Patients also complained about the ‘callous attitude’ of health workers.
‘Night staff seems to be especially likely to treat patients callously,’ notes the review.
‘In Mpumalanga, patients complained that night staff come and chat until eleven o’clock and when they are called they usually don’t respond. This is made worse by the fact that the bells on patient beds are often not working and on occasions critically ill patients have fallen from their beds trying to get assistance.
‘Nurses have been found making up their beds at around 8pm and getting ready to settle down for the night.’
The overall impression is that the health system is underfunded and battling to meet demand, particularly as the HIV/AIDS epidemic has ‘quickly absorbed’ funding increases, notes the report.
The SAHRC concludes by recommending that constitutionally ‘the right to health’ needs to be defined in practice and linked to what health services need to be in place ‘to qualify as providing access’.
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