NHI pilot district “shows signs of collapse”

File Picture: Itumeleng English
Health-e News citizen essential medicine monitoring has picked up drug stock outs since February
Health-e News citizen essential medicine monitoring has picked up drug stock outs since February

Even Mpumalanga’s Gert Sibande District, one of 11 districts nationally piloting the National Health Insurance (NHI) scheme, is facing severe problems despite getting an extra R1-million NHI conditional grant.

The NHI aims to improve health service delivery by strengthening clinics and harnessing the resources of the private and public sector, and government is contracting private doctors to work part-time in the public sector.

Dr Christel Mhlabase* is one of these doctors. Yet she is deeply frustrated as, in her first three months working in the public sector, she had already seen one death due to a lack of basic equipment.

A mother entered her office cradling her baby who had just died of dehydration, said Mhlabase. Had the clinic had basic equipment, she might have been able to save the 2-month-old child.

“If I had the basic equipment at my disposal, chances are I could have saved the baby,” said the doctor, who asked not to be name for fear of being victimised. “Basic tools that a doctor would need such as oxygen masks, drips … and blood pressure monitors are not available.”

Without such equipment, Mhlabase said her clinic has to transfer patients to the nearest hospital – yet the aim of the NHI is to strengthen primary health services to take the pressure off hospitals

NHI pilot district shows “signs of collapse”

[quote float=”right”]“If I had the basic equipment at my disposal, chances are I could have saved the baby”

Linda Mavuso, provincial co-ordinator of AIDS lobby group the Treatment Action Campaign (TAC), says that three years into the NHI pilot, the community is seeing “signs of the collapse” of primary health services instead of the promised improvement.

The Gert Sibande District has one of the country’s highest HIV prevalence rates among pregnant women, according to the country’s most recent antenatal HIV survey.

Yet most health facilities in Govan Mbeki Municipality around Secunda have been running low on HIV testing kits for two months, according to Mavuso.

“They had seven test kits which they reserved for pregnant women at one clinic,” Mavuso told Health-e News. “The shortages of HIV tests kits defeats the purpose of scaling up HIV prevention in the district.”

In October 2013, a decision was quietly made to place the province’s department of health under the administration of the Mpumalanga Department of Finance. The MEC for Finance is now responsible for financial decisions made by the Department of Health, which retains control over human resource decisions, according to Mpumalanga Department of Health spokesperson Dumisani Malamule.

At the time, the finance department admitted that the health department was in danger of collapsing due to huge overspending in areas such as employee compensation and large accrual of past debt..

By the end of the 2013 financial year in March last year, Mpumalanga’s health department had accrued a debt of about R247-million.

According to Thoko Madonko of the civil society Budgetary Expenditure Monitoring Forum, the department is set to over-spend its by nearly R500-million.

The Department of Finance has already put in place austerity measures to cut spending, but this is having a knock-on effect on services

Orthopedic services in the province are severely dysfunctional. There are widespread staff shortages and stock-outs of essential medicines such as insulin for diabetics, children’s vaccines and HIV and tuberculosis treatment.

Drug shortages uncovered

[quote float=”right”]”By the end of the 2013 financial year in March last year, Mpumalanga’s health department had accrued a debt of about R247-million”

Although Mpumalanga Department of Health spokesperson Dumisani Malamule denied stock outs were occurring, documentation obtained by Health-e News shows that some medicines ordered by local clinics were not even available at the provincial depot.

Health-e News Service’s citizen journalist monitoring of a small number of clinics have also recorded stock outs since February.

Duduzile Ngwenya’s epileptic son risks brain damage if he does not get medicine to control his seizures, but his mother has battled since January to get the medicine.

“The nurses just say there is no treatment and that I must come back and check after a week,” says Ngwenya, who added that the clinic has also lost her son’s file.

“Without his treatment, he gets seizures, but without his file it makes it hard for me to try collect medication from another clinic,” adds Ngwenya, who has resorted to paying a private doctor.

Last December, World AIDS Day was commemorated in Gert Sibande District to draw attention to its massive HIV burden. At the time, the TAC sent a letter to then Deputy President Kgalema Motlanthe, expressing concern over health workers’ working conditions, budget overspending and vacant posts but nothing has changed.

“At the Ermelo Town Clinic, the infrastructure is poor, there is lack of equipment and a shortage of staff,” said Sifiso Nkala, NHI coordinator for the public interest law firm Section27. “I have never seen such bad working conditions.”

Staff shortages blamed for long wait times

In the district alone, 40 percent of doctors’ and pharmacists’ posts are vacant and 22 percent of professional nurses’ posts, according to the Department of Health’s latest annual report.

Patients like Ayanda Msibi and her seven-month-old baby pay the price. Msibi recently arrived at Secunda’s Embalenhle Extention at 6 am after her baby developed flu. By 1pm, the mother was still waiting outside and had not even reached the admissions desk.

Only three nurses work at the clinic and one must switch between admitting patients and manning the pharmacy. Msibi left without receiving help, opting instead to visit a private pharmacist.

Nkala said that there seems to be no clear human resource plan by the government to attract or retain health professionals. 

“We have about 294 doctors in Gert Sibande, but government is failing to retain them,” Nkala told Health-e News. “They just end up getting frustrated and exiting public healthcare. This system is failing them daily.”

The Mpumalanga Department of Health acknowledged shortages of basic equipment at clinics and blamed the these on various reasons, including delayed purchases and deliveries, according to spokesperson Dumisani Malamule.

He added that the problem was also highlighted during Health Minister Dr Aaron Motsoaledi’s 19 August. During Motsoaledi’s visit, the department decided that district specialist health teams must begin auditing clinics to ensure basic equipment is in place in line with national guidelines. Missing equipment will be procured with immediate effect, he told Health-e News.

Additional reporting by Laura Lopez Gonzalez

An edited versions of this story first appeared in the 22 August edition of the Cape Times and The Star newspaper

Read more on Mpumalanga’s health crisis as part of Health’e News’ “Deadly debt” series:


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