The Mpumalanga Department of Health is faced with a dire shortage of human resources, which include doctors, pharmacist assistants, professional nurses and other staff. 

The recently released Mpumalanga State of Health report by Ritshidze, a community monitoring organisation, indicates that human resource shortages within health facilities in the province have worsened over the past year. 

43 health facilities across the province were monitored. The report details only 35% of facilities reported enough clinical and non-clinical staff, which is a regression from 41% in 2022. 33% of facilities blamed too few open positions on the shortages, and 22% blamed unfilled vacancies.

In February this year, a  third-quarter health committee report tabled in the Mpumalanga provincial legislature revealed there are 34 health facilities without an appointed operational manager, and a shortage of essential staff members such as pharmacist assistants, data capturers and nurses. 

The health report also revealed that 144 primary health care facilities in the province do not have a visiting doctor and over 200 clinics remain without a back-up generator for electricity.

Staff shortages

Speaking to Health-e News, Ritshidze Project Officer, Ndivhuwo Rambau, says that while Mpumalanga health services have improved since Ritshidze started monitoring health facilities in the province in 2021, a gap remains between the staffing needed to ensure high-quality services and current staff numbers.

“There is still a long way to go to fill the human resource gap that undermines the HIV and TB response. Improving the state of health services provided at our clinics, mainly depends on having enough qualified and committed staff in place,” says Rambau.

Rambau says that of 2,284 public healthcare users interviewed in their latest report, only 53% said there was always enough staff to meet the needs of public healthcare users.

“Of the 43 managers, 65% reported there was not enough clinical and/or non-clinical staff at the facility, worsening from 54% last year. According to facility managers, the most commonly understaffed cadres were professional nurses, enrolled nurses, enrolled nurse assistants, and data capturers. The most common vacancies were among data capturers, enrolled nurses, and pharmacist assistants,” says Rambau.

She says that some of the facilities specifically wanted additional human resource support from PEPFAR district support partners in the province, Broadreach and Right to Care. However, in recent years, PEPFAR’S funding for critical human resource posts has only been reduced.

Waiting times

“Staff shortages impact the waiting times in facilities. In most instances patients report that they have to wait longer due to there not being enough staff at facilities. A lack of staff also exacerbates staff attitudes as most health workers are often overworked and overwhelmed,” says Rambau.

There was a wait time of 3 hours at 27 facilities that were monitored.

“This is a very long time to spend at a facility in which people are usually only seen for a very short consultation and this is a major source of dissatisfaction for those who experience the long waits. For people living with HIV either collecting refills through standard dispensing or at facility pick-up points, or returning to the facility for a rescript, spending an extended time at a facility increases the risk of that person interrupting treatment or disengaging from care,” explains Rambau.

Despite a circular having been issued in May 2019 by the National Department of Health requesting all healthcare facilities in the country to open by 5am on weekdays, Rambau says that most facilities in Mpumalanga are still yet to adhere to the call as they continue to only open after 7am.

“Commonly, facility managers tell us that they are unable to extend opening hours due to insufficient staffing to cover this time. Yet 2,257 of public healthcare users whom we spoke to,  think that  extending hours would improve access to services,” she says.

Patient dissatisfaction

Thando*, a patient, interviewed by Ritshidze, uses a mobile clinic service in the Amsterdam area in the Mkhondo local municipality.

“There are also only two nurses and they are very slow, sometimes even when they come early, they only leave the village by 6pm. And all that time we wait in the sun or the rain because there is no shelter,” says Thando*.

“They also do not care about us patients or to give us some dignity. They are unprofessional, they just scream out peoples names at the mobile clinic. It is people who aren’t  in the queue, people who don’t live there anymore and even people who have died, but they just do not care,”.

Another patient, Lena* who lives in Bethal says her clinic appointments at Sead Clinic often leave her frustrated and angry.

“The clinics do not respect our time, that is why they do not honour the appointments and that is why they do not care that we must wait for long,” says Lena*. She says that her other complaint is that nurses do not answer questions or take time to explain things to patients. She says that even now she does not fully understand what her blood test results mean.

“All they tell me is that i am doing okay, but they do not explain what it means and this is something that i want to understand for my own body. The relationships between nurses and patients break down in anger, patients feel they do not want to ever return and it is how people end up stopping treatment,” she says.

The provincial health spokesperson, Dumisane Malamule, did not respond to questions on on how the department plans to address staff shortages. –Health-e News.