As of June, the Free State’s Bloemfontein medicine depot had run out more than 200 essential drugs and supplies including HIV testing kits, at least six different antiretrovirals, as well as most medication and supplies to help control hypertension and diabetes, according to a joint statement released by public interest group Section27 and AIDS lobby the Treatment Action Campaign (TAC) late last week.

• Read the full list of missing medicines and supplies

According to Section27 Executive Director Mark Heywood, financial mismanagement and huge debt are likely at the root of the health system’s malaise. While patients, doctors and activists can see the effects of what they say is a financial crisis, no one knows how deep the crisis is.

“The Free State has been in an on-going financial crisis, accruing debt and spending last year’s debt in next year’s budget,” said Heywood, who added that the crisis has been on-going for at least five years. “We are hearing from a number of sources that…basically two months into the financial year they are already running out of money for certain key health services.”

In 2008, a financial crisis led to an ARV moratorium in which clinicians were instructed not to start any new HIV patients on treatment

[quote float=”right”]“The Free State has been in an on-going financial crisis, accruing debt and spending last year’s debt in next year’s budget”

“The province has to come clean as to what its financial position is,” said Heywood, adding that health workers have reportedly been given numerous reasons why services have been cut and posts left vacant including that the province is attempting to services its huge debt to the National Health Laboratory Services (NHLS).

In 2012, the Free State owed the NHLS R36 million and the province, alongside Gauteng and KwaZulu-Natal, accounted for the bulk of back pay due to the NHLS in 2013.

The province’s financial crisis has already caused hospitals in Bloemfontein and the eastern Free State to halt elective surgeries and, in the province’s east, turn away non-emergency patients, according to the activist groups.

According to Section27 and the TAC, they have spent more than a year attempting to engage provincial and national leadership on the Free State’s latest health crisis to no avail.

Now, the groups have demanded that the minister of health, finance, and co-operative governance and traditional affairs immediately deploy a task team to the province to identify drug, equipment and health worker shortages.

“You need to take short term steps to staunch the immediate crisis but then you need a longer term intervention to remedy the financial chaos that appears in that department,” Heywood said.

According to National Department of Health Spokesperson Joe Maila, the National Department of Health has been aware of the Free State department’s financial difficulties.

“We have deployed several teams to the province with the aim of diagnosing the problems and providing assistance,” Maila said. “We are eagerly waiting for their report and strong recommendations that will enable us to turn things around for the better in the province.”

Teams were due to report back to Director General of the National Department of Health Precious Matsoso Friday, 20 June.

How much power does national have?

[quote float=”right”]“If you have people at the top who are tainted by allegations of corruption, it doesn’t really help”

In 2011, Cabinet deployed a team to Limpopo to take over some provincial departmental powers as part of Section 100 1(b) of the Constitution. This section allows the national executive to intervene in a province should it not fulfill its constitutional obligations by, for instance, maintaining a minimum standard of service delivery

Limpopo’s Section 100 take over came after it became clear that the province would not have enough money to pay teachers, health care workers or other public sector employees.

According to Heywood, the Free State seems ripe for another such intervention but the National Department of Health may not have the manpower.

“Constitutionally, this seems to be exactly the situation envisioned where a Section 1(b) intervention is not just necessary but a duty on government,” Heywood told Health-e News. “The Free State is failing to provide legally-mandated health services and comply with the norms and standards set by the minister.”

“The problem is the National Department of Health says it doesn’t have the capacity to take over another province,” he explained. “Politically, there’s an issue that is that the National Department of Health doesn’t have the power to remove the ‘rotten apples.’”

“If you have people at the top who are tainted by allegations of corruption, it doesn’t really help,” said Heywood.

The National Prosecuting Authority is currently pursuing a case against Free State MEC for Health Benny Malakoane for alleged fraud and corruption linked to his former role as Municipal Manager of Matjhabeng Municipality.

In late 2013, the two groups led a coalition that outed what it said was a similar collapse of health services in the Eastern Cape. Heywood says they have seen marked improvements in some areas of the Eastern Cape since the coalition highlighted poor care there. The two groups have also highlighted serious problems in Mpumalanga’s provincial health system.

The Free State Department of Health had declined to comment at the time of going to print but spokesperson Mondli Mvambi said he expected the department to issue a statement soon. – Health-e News Service.

An abridged and edited version of this article first appeared in the 21 June editions of the Pretoria News, The Saturday Star and the Saturday Weekend Argus.