Eastern Cape: Health system reform debated
Port Elizabeth – Drug shortages and lack of ambulances emerged as some of the most pressing health system issues in the Eastern Cape following a recent meeting of community based organisations.
Organised by the Black Sash in partnership with the University of Cape Town’s Health Economics Unit and Health-e News Service, the provincial health workshops will travel to all provinces in South Africa culminating in a report which will be shared with Government once public consultations are held on National Health Insurance (NHI).
Community based organisations have been invited to participate in provincial workshops and share their experiences of the health system and what they would like to include in any health system reform being debated as part of the NHI discussion.
In the Eastern Cape participants spoke of tuberculosis drug shortages, long queues, lack of accountability, a broken referral system, poor treatment of patients by health workers, a weak primary health care system and the long distances patients have to travel.
One participant spoke of diabetes patients travelling long distances to collect their supply of insulin only to be told there was no stock while another participant spoke of TB patients being forced to wait in long queues on empty stomachs only to be told that there was no drugs.
A health worker shared a story of a patient with a serious medical condition who had been transferred to a central hospital four hours away while the hospital falling in another province was much closer. An ambulance took very long to arrive and the patient died underway to the hospital.
‘It’s hard for me that patients are dying of conditions that can be treated if we had enough health workers in the rural areas,’ she said.
An elderly community worker from the Port Elizabeth area shared the story of a diabetic patient who had injured her toe leading to her foot being amputated. ‘She was never educated on the dangers such an injury poses to diabetic patients and she didn’t know how to care for the wound, a couple of weeks later they had to amputate her leg above her knee,’ she said.
The community worker went in search of the patient in the local hospital and described her shock at finding her with dirty bandages and no staff to attend to her.
‘There was no water, no bed pan and not enough staff to change her dressings. Her wound was a gaping hole, it was terrible. They wanted to amputate the leg even further and I refused to allow them to do this,’ she said.
She managed to use her contacts to take the patient to a private clinic where they managed to heal the wound. ‘Money gets everything right,’ she remarked wryly.
‘Our patients don’t see the point of going to the clinic to be treated if the treatment is sub-standard or absent,’ she added.
Participants said the lack of ambulances, for patient transport and trauma incidents was a major concern. One man said they had waited two hours for an ambulance to arrive at an accident scene near Flagstaff.
Participants also engaged on issues of financing the health system as well as the inequitable distribution of money and health care resources with hospitals, private and public, mostly found in urban areas with reduced access in areas where poorer households are situated, but where the health needed is often much bigger.
- Eastern Cape has the highest poverty levels in South Africa (48% compared with SA average of 33%)
- Eastern Cape has the second highest percentage of children under the age of 15 (37% compared with SA 32%) and population living in rural areas (61% compared to 43% in SA)
- The Eastern Cape has the lowest access to electricity for lighting in SA (65% compared to 80% in SA)
- The Eastern Cape has the lowest access to piped water (70% compared to almost 90% in South Africa)
- The Eastern Cape has second worst access to flush toilets in South Africa. Limpopo is the worst off. Access in the Eastern Cape is 40% and 60% in SA (20% in Limpopo).
- In the Eastern Cape infant deaths (children under 1 year) are 60, compared to the SA average of 45. This translates into 65 of every 1 000 infants (live births) dying before they reach one year.
- The death rate in children under five years is almost 90 in the Eastern Cape with only KwaZulu-Natal slightly higher. The SA average is just over 70. This means that 90 of every 1 000 live births in the Eastern Cape end in death before the child turns five.
- Government health spending in the Eastern Cape is under R1 500 per person per year, the lowest in the country.
- The Eastern Cape has also recorded the second lowest number of doctors working in the public sector (17 per 100 000 people).