The Office of the Health Ombudsman is battling to resolve serious complaints against health facilities. Classified as high and extreme risk, these complaints involve death in a health facility, or a patient losing a body part due to negligence by healthcare workers.

The health ombud is South Africa’s watchdog that investigates complaints of negligence by healthcare workers in health facilities – public and private – lodged by members of the public. But budget constraints means the watchdog can’t employ enough investigators to look into the many violation complaints.

“The office is facing a shortage of staff members which has contributed to several unresolved complaints,” ombudsman Professor Taole Mokoena tells Health-e News. 

In a response to questions before Parliament last month (March) health minister Joe Phaahla said between 2018 and 2023, 307 high and extreme-risk complaints were submitted before the office. Less than half – only 148 – of the complaints have been resolved. A total of 159 remain unresolved.

Consequences of backlogs

Dr Larisse Prinsen, senior lecturer of public law at the University of the Free State, warns that unresolved cases have an impact on healthcare and quality of services.

“Unresolved investigations and cases can lead to a lack of accountability and transparency in the healthcare system. 

“When these cases are left unresolved, a perception could be created that healthcare providers are exempt from the laws, rules and guidelines that regulate the healthcare sector in South Africa. This, in turn, might potentially lead to increased instances of negligence or malpractice,” she says. 

Unresolved complaints, Prinsen says, might also undermine public trust in the healthcare system. 

“Failing to resolve these cases might lead to continued systemic issues in healthcare facilities or establishments such as low standards of care, the overlooking of mistakes or unethical, unprofessional or unlawful behaviour.” 

Chronically understaffed

Between 2016 (when its doors opened) and 2023 the office received more than 14,000 complaints. 

A bulk of the complaints (96% or 13,791) submitted are low-risk and can be resolved by the complaints call centre. A minority of the total complaints are high (0.79% or 112) and extreme (0.32% or 45) risk. Health-e picked up discrepancies in the numbers of high and extreme risks complaints between what the minister cites in his response to Parliament versus what is recorded in the health ombud’s 2022/2023 annual report.

When asked for clarification Mokoena says that the 159 unresolved cases referred to by Phaahla are backlog cases from the unit’s inception from 2016 to the end of the 2022/23 financial year. He says the 45 extreme risk cases shown in the annual report were received during the 2022/2023 financial year. 

These high and extreme risk cases require a robust analysis and investigation process, and are handled by the complaints investigation unit. 

But the unit is severely short staffed.   

According to the health ombuds’ annual report for 2022/23, the unit operated with “vacancies of Director: Complaints Investigation (1), Investigator: Legal (1) and (2) Investigators (Health). An Administration Officer provides administrative support for the two sections.” 

In his Parliamentary response Phaahla says the health ombud’s office has been short staffed since it started operating in 2016. 

Ombudsman Mokoena says his office has been granted funding under the Medium Term Expenditure Framework to appoint additional personnel to address outstanding backlog complaints.

“However, this is not sufficient to handle new and ongoing complaints. There is a plan to request funding for special temporary staff to address the outstanding backlog,” Mokoena says. 

An organogram put forward at the first Presidential Health Summit in 2018 proposed a complement of 113 staff with a budget of R132 million over a five year period for the health ombud office. But there’s been little movement in this regard. 

“In fact there was an admission that nothing has been done in the last Presidential Health Summit (May 2023) and currently the budget of the [Office of the Health Ombudsman is approximately R23 million far short of the ideal proposed budget five years ago,” reads the ombud’s annual report. 

In his Parliament response, Phaahla says the allocation from the medium term budget will go towards employing the current staff in the ombudsman office on a permanent basis. This is meant to boost the number of investigators. 

“However, additional funding will still be required to appoint permanent staff to augment the capacity and ensure that the mandate of [the office] is fulfilled,” Phaahla says. 

Competing priorities 

South Africa’s health budget is under severe pressure. The department has been faced with unrelenting protests from unemployed doctors and other health workers demanding placement. At the same time, public health infrastructure desperately needs revamping and health workers are overstretched. 

A particular strain on the health budget is medico-legal claims which have skyrocketed. Recent estimates point to a 23% rise in such claims in the public sector since 2014. 

According to Phaahla’s parliamentary response to the DA’s questions, R23.6 billion has been paid in medico-legal claims across all provinces from January 2020 to December 2023. Of this, R1.3 billion was spent on the legal costs for these cases.

Health-e News asked the ombudsman if there is a connection between the cases his office  has not resolved and medical litigation. Mokoena says there has been “no clear evident connection”.

But medico-legal claims are based on instances of medical negligence or malpractice, similar to the high or extreme risk cases investigated by the ombudsman’s office. 

The health ombud has investigated several high profile tragedies over the years. These include: 

• The death of 141 mental health patients in the Life Esidimeni Scandal in October 2015.

• The death of Covid-19 patient Shonisani Lethole at Tembisa Hospital in June 2020.
• Harrowing conditions for pregnant women at Rahima Moosa Mother and Child Hospital sleeping on the floor in April 2022. 
• Allegations of patient mismanagement and patient rights violations at Tower Psychiatric Hospital and Psychosocial Rehabilitation in Komani, Eastern Cape in August 2018.

Prinsen believes that resolving cases efficiently through the health ombud could mitigate the need for litigation by providing timely and satisfactory resolutions to complainants. 

“When wronged patients feel that their complaints are not or have not been adequately addressed, they may resort to legal action to seek redress for the harm suffered. These unresolved cases then add to the increase in medico-legal litigation being observed in South Africa,” she says.  – Health-e News