The Gauteng health department has come under criticism for its deplorable human resources management, which has incentivised employees to exaggerate their leave days.

These concerns were raised during a meeting on the Policy and Procedure for Incapacity Leave and Ill Health Retirement attended by the CEOs and HR managers of various divisions in the department earlier this month.

The meeting examined the number of staff members who have exhausted their 36 days of sick leave over the three-year cycle, during which they are entitled to 12 days a year, and those who are subsequently placed on unpaid leave once their 36-day entitlement has been used up.

According to a source who also attended the meeting, an audit is currently underway to verify the number of employees who have taken unauthorised incapacity leave a type of leave taken by an employee when they are unable to work due to ill health or injury, and they have exhausted their standard sick leave.

 “The issue of employees resorting to incapacity leave after exhausting their sick leave days emerged during the department’s Ziveze campaign (Reveal Yourself) to root out ghost employees,” he says.  

He adds that, as part of the same campaign, the department froze the salaries of 188 employees at the end of April after they failed to report for physical verification at their workplaces.

Unauthorised incapacity leave

The Gauteng Department of Health has pledged to review cases where employees were granted incapacity leave without the required approval from the health risk manager.

Department spokesperson Motalatale Modiba states that there are currently 20 employees on long-term temporary incapacity leave. Incapacity leave is initially granted for 30 days, but if the employee remains unwell, medical documents must be submitted to the health risk manager for further assessment.

Between the 2021/22 and 2024/25 financial years, a total of 8,571 employees have exhausted their sick leave entitlements.

Professor Alex van den Heever, an adjunct professor at the Wits School of Governance, says a formal committee must assess employees requiring prolonged incapacity leave and, where appropriate, be classified as incapacitated.

“Staff members deemed legitimately incapacitated would then become the responsibility of the Government Employees Pension Fund (GEPF) as they would be forced to retire, rather than being funded through the provincial health budget,” he explains.

“However, if the incapacity is found to be unjustified, the GEPF will not accept the determination. Where prolonged incapacity is being improperly accommodated, this violates the Public Finance Management Act and should result in appropriate disciplinary action against the accounting officer or head of department,” van den Heever says.

Cost of unauthorised leave

Van den Heever says that failing to manage the personnel budget properly can have far-reaching implications across the department.

“If the issue of unauthorised or unapproved incapacity leave persists within a provincial health system, the financial cost could be significant,” he says.

He says that the Gauteng Department of Health employs approximately 76,000 people, at an average cost of R471,000 per employee.

“In the 2023/2024 financial year, personnel expenditure totalled around R38 billion, making it the largest component of the department’s budget,” he says.

He adds that inadequate resource allocation for service delivery resulting from poor budget management ultimately compromises patient care.

Organogram not updated in over two decades

Democratic Alliance Gauteng health spokesperson Jack Bloom describes the department’s human resources management as “abysmal”.

“They haven’t updated their organogram in more than 20 years,” he says. “Moreover, Gauteng health has been without a permanent chief HR director for the past seven years.”

Modiba says the issue of the organogram is a longstanding one that the Gauteng Department of Health has been reporting on to various oversight bodies for some time now. 

“The organisation structure is among the issues that the MEC for Health and Wellness Nomantu Nkomo- Ralehoko prioritised when she was assigned to the department in October 2022. The department has since embarked on an organisational structure review which it has completed and is now engaged in an extensive consultative process with stakeholders internally and externally,” he says.

“The post of the Chief Director: HR was previously advertised and the department could not attract suitable candidates. This post has been prioritised and is one of those that are earmarked to be filled within this financial year,” he says.

Policy perspective

Van den Heever says from a policy standpoint, there must be systems in place to ensure that incapacity leave is managed fairly for employees while remaining financially sustainable. The Head of Department (HOD) holds ultimate responsibility for the department’s financial management.

“If the HOD is being shielded from accountability, then the provincial and national Treasuries should initiate action against the accounting officer, including seeking their removal and, if appropriate, pursuing criminal charges,” he says.

He says in this case, the leave-related expenditure is considered irregular, and it is the accounting officer’s duty to take corrective and preventive action. A consistent failure to do so renders the accounting officer’s position untenable.

“If there is a systemic failure to prevent and address irregularities, the accounting officer’s position becomes untenable,” he says.

He adds that the problem often stems from a breakdown in the executive’s supervisory role, especially when conflicts of interest arise from their involvement in appointing the HOD.

“This conflict can obstruct accountability, particularly when transgressions occur, as the executive member may be complicit,” Van den Heever says.

“There is, therefore, a systemic failure in oversight structures, not because legal frameworks are lacking, but because they are simply not enforced,” he says.

As a solution, Van den Heever advocates for a structural separation between administrative functions and executive authority to eliminate opportunities for collusion.

“This reform should apply to all leadership appointments within the public health system,” he says. – Health-e News