Minister – Responding to the IST
The Integrated Support Team (IST) identified that huge weaknesses in provincial health departments were behind the R7.5-billion debt accumulated, mainly by Gauteng, KwaZulu-Natal and the Eastern Cape. Weaknesses included a bloated bureaucracy, poor financial management and inadequate monitoring.
The confidential findings of the IST, appointed by previous health minister Barbara Hogan to investigate problems in the provinces after the Free State ran out of money in late 2008, were leaked last month.
‘We have put up systems since we received the IST reports and we are very far. The first thing we did was to analyse whether it is true that health is underfunded. Because there was war here, a very serious war between health and finance. Finance was saying health is lying, they are not underfunded, they just mismanaging. Health was saying, they are talking nonsense, they are trying their best and are underfunded. But the answer is not either or. It’s none of the two, it’s both,’ said Motsoaledi.
As a first step the national and provincial health department established a team of Chief Financial Officers (CFO). The CFO forum was instructed to take the IST recommendations and find a way to implement them ensuring that budgets are in line with the priorities. Practically this would mean that if the minister and the MECs agreed that immunisation was a priority, budgets had to reflect this.
Motsoaledi said he would not hesitate in instructing provincial treasuries to shift the budgets of those provinces who had agreed to a health programme, but did not dedicated the funds to it.
The team has also been working to get rid of the massive deficits in the provinces which saw some health programmes grinding to a halt. The Free State ran out of money in 2008 and placed a moratorium on the treatment of HIV positive patients.
Another intervention was to re-align the health department’s organisational structure. ‘We know that the area at the coal face of delivery has been ignored for a long time. Posts were being created at the management level ignoring the need lower down and it’s wrong, it’s absolutely wrong and the IST report identified it and we have been working around the clock,’ said Motsoaledi.
Another major issue identified by the IST reports was the poor state of many hospitals and clinics with little or no effort to maintain them. In response Motsoaledi has appointed Dr Massoud Shaker, an engineer who also assisted him when he was Education MEC in Limpopo. Shaker has established a forum and is in the process of appointing an engineer in each province. The forum will oversee any new infrastructure projects and have already done a national analysis of what is required. They will also monitor the maintenance of facilities.
Motsoaledi said previously any infrastructure issues were handed over to Public Works.
‘They don’t work in the department, they don’t know our problems, they don’t know our needs, they don’t attend management meetings.
‘The the Auditor-General has criticised us and shown us some pictures of konkelwerk’¦which was done in the building of clinics and hospitals. He reprimanded us ‘ and why was the konkelwerk done? Because we had no people monitoring this thing. Our new system is working miracles and we are already far advanced within a very short space of time,’ said Motsoaledi.
Motsoaledi said when he employed Shaker in Limpopo ‘we achieved in 2 and half years what we could not achieve in 12 full years’.
‘I don’t want to hear that story about a toilet being blocked or going to Bara and seeing a ceiling hanging and being told we have been waiting for Public Works for six months,’ he said, adding that no new facility will be built without a clear maintenance plan.
Another high level process taking place was an overhaul of management at hospital level. The investigation is overseen by Development Bank of South Africa and Motsoaledi said he was expecting a final report shortly.
‘I wanted the DBSA process to get down to the root of the problem. Is a hospital not functioning because the person heading it is completely out of their depth? Or because this person was put there without delegations? Or is it because they put a wrong person there all together who even in the next 100 years will never improve, because it is the wrong person from the beginning? Some of the problems are already know, but I want them to come to me in a scientific, systemic way,’ said Motsoaledi.
‘Some of the CEOs will tell you my hospital is dirty because I don’t have delegations from the provincial government to repair the cleaning machine. They will say the tender is with the province. Some will say, no the window is broken, I don’t have delegations, the tender is in the provincial department. There are many examples. Why was infection control not there? No, we ran out of detergent, we are waiting for the tender from the provincial department. As I am sitting here there are already hospitals which I know are dysfunctional. Just by visiting there you can see that this hospital is not functioning,’ said Motsoaledi.
He also hinted that managers in the national department could also come under fire. ‘We have managers here whose jobs and functions have got nothing to do with the outcomes you want and whose functions and jobs were found to be erratic by the IST reports. Once we have dealt with that I will be able to state that I have the management tools I want,’ said Motsoaledi.
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