Speech notes by Celeste Barker MPL, speaking on the budget vote for the Department of Health, 16 May 2017

Honourable Premier, Madam Deputy Speaker, Colleagues and guests.  Molweni Nonke! It is a privilege to greet you today.

Health affects the quality of life of every single person in the Eastern Cape and it is therefore fundamental to the wellbeing of our people of that the Department conforms to global best practice and nurtures the lives of every single soul in the Eastern Cape.

One way to do so effectively is to adopt the principles of the WHO – the World Health Organisation – and its definition of health as  “ … a state of  complete physical, mental and social wellbeing and not merely the absence of disease or infirmity”.  All on this basis state patients should receive fair, thorough treatment extends to include protection of the rights of that young, women who seek abortions at our state facilities.

As indicated in the Committee Health report, this is a lifesaving mandate but the Department cannot guarantee reliable of health services delivery because it lacks the resources to do so and is beset by debt that outstrips its budget.

This statement is not made lightly.  Evidence of a health crisis has been coming for months.  On 17 February this year an article in the Daily Dispatch proclaimed in print that “Sheriff seizes vehicles to settle Health Bills”. The article exposed an unpaid medico legal claim of R 16.8 Million Rand in damages to the mother of a child who suffers from severe cerebral palsy due to medical negligence in one of our hospitals.

Secondly it was reported that Departmental assets including its Building, all vehicles, and all furniture and equipment attached to it would be auctioned to cover the costs of unpaid legal bills and court orders. (EP Herald : 10/05/17)

Thirdly our most demanding challenge is the burden of an accumulated, unfunded mandate for an increasing medico-legal debt and a contingent liability currently standing at R11.4 Billion. While the Department  deserves recognition for its attempt to limit medico legal costs by appointing an Ombudsman to investigate medico legal cases it failed to act immediately instead of facing the harsh reality that conditions in many of our Provincial facilities contribute to the burdens of disease, death and disability.

Soren Kierkegard, the Danish philosopher, wrote that “Mankind cannot bear too much reality”.  His observation may be true and may also be one of many reasons that the Department of Health failed to openly acknowledge medico legal challenges – as soon as the very first medico legal bills started to roll in.  This is a crying shame! It has contributed to a nerve wracking climate for our patients in which drug stock outs, equipment shortages, theft and burglaries rendered facilities unusable while mop up jobs took place.  In instances of recurrent break ins and vandalism at the New Brighton Clinic in the Nelson Mandela Bay Metro (NMBM) a mop up operation after flooding caused by theft overflowed into the waiting room and made it impossible for queues of HIV AIDS patients to receive their ARV’s on time.  Similarly the distribution of Psychological drugs stopped without warning at some facilities. In both circumstances lives and health were risked.  This is morally indefensible!

A report in the Sunday Times (March 19 2017) lists the “Most dangerous Provinces for Moms with newborns.  The Eastern Cape is ranked fourth and North West is the most dangerous place to deliver babies in SA. As most medico legal claims arise from gynaecological and obstetric complications this crisis urgently requires an injection of specialised skills to reduce both medico legal claims and maternal and infant mortality.

As the DA aims to build not break we want our Department of Health to flourish and get rid of its cumbersome financial burden. We also want it to be the shining crown jewel of good health management in South Africa. And we want it to provide the best state health service in the country! For this reason the Democratic Alliance offers a suggestion and an example of how change can be made.

This simple suggestion is to exercise hindsight and to avoid any repetition of past mistakes. For example in 2007 at the time of Mbeki’s Presidency, a scandal broke because of AIDS denialism, the quality of care and deaths of new born babies at the Mount Frere Hospital. (Daily Dispatch in Habib : 2013: 8).

The then Minister of Health reverted to a state of denial. Those who broke the story and those who tried to address the care and baby deaths issues were reprimanded and harassed.  The then Deputy Minister of Health – Nosizwe Madlala Routledge –  conducted an unannounced oversight visit to the Mount Frere Hospital,  confirmed the dire conditions at the hospital and lost her job because of it!!

After the Holocaust and Hitler’s cruel extermination of the Jewish people a museum was built in memory of lives lost. The walls of the museum are inscribed with the words “Lest we Forget”.

Given the dire financial straits of the our Department of Health the DA humbly calls on the powers that be to remember and use the lessons of our past “lest we all forget”

This is a way to avoid the repetitive challenges that frustrate patients, restrict service delivery and embarrass the Department.

In response to the budget vote the DA recognises and values an increased allocation that has grown by 7% from the 2016/17 financial year to R21.707 billion.

We are most distressed by the impact of medico legal claims on the Department’s budget and support recommendation (b) of Programme 1 that the Department must submit a comprehensive, evidence-based report on its medico legal findings and use this report to secure support from Treasury and/or The Office of the Premier.  We look forward to receiving this report in 30 days and to contributing to a solution.  Unfortunately the matter of the Department of Health’s non-existent organogram has been limping along since the beginning of this term of office in 2014 and to date – despite much talk – has yet to be seen.  This is simply not good enough! It makes a mockery of planning and suggests that for at least the last 2 and a half years, planning has been ad hoc, incomplete and therefore doomed to fail.

The province is embarrassed by feedback that the Department failed to plan its recruitment budget with sufficient care and that the outcome of this feedback is that the allocated amount of R 156 million is inadequate and that yet again vacancies will not be filled!!  This is likely to have a very negative effect on staff morale and performance. At the moment our health facilities experience staff shortages when members take legitimate leave and temporary staff are not appointed to I carry their loads. This planning failure could not have come at a worse time!

The DA supports recommendations made for Programme 2. It is essential that data in the Primary Healthcare environment should be reliable and well managed to prevent health risks.

Under Programme 3, Emergency Medical Services, the DA is appalled by long turnaround times that put patients at risk and funds that have been wasted on training for a non-accredited course! This money could have been spent way better and there must be consequences for such fruitless and wasteful expenditure. We support the recommendation and look forward to receiving the report within 30 days.

Psychiatric facilities (Programme 4) require urgent attention.  The situation has become dire and floor beds are not the answer. Historical imbalances in service provision need to be equalised as is being done with the Cecilia Makiwana Hospital.  There is also absolutely no justification for a disproportionate allocation of the National Tertiary Grant Funding in the Eastern Cape(Programme 5)

Ladies and Gentleman we have reached a crossroads in Health Provision in the Eastern Cape.

  • Medico Legal claims of approximately 14 Billion Rand will deplete our budget allocation of 21 Billion
  • We have a contingent liability of 11.4 Billion
  • The DOH has not delivered an organogram
  • The CFO commented that our Health budget is insufficient to last a year.
  • Money for service delivery is being transferred to fund Medico Legal costs
  • 5000 Staff members left the service of the DOH at the end of 2016
  • Only 3000 have been employed. The Department cannot afford to pay more, hence 2000 jobs have been cut to pay Medico Legal bills

This is not a good story to tell.  This action will exacerbate hardship and add to the growing pool of unemployed people in our province.

Honourable members, a health budget should not be designed simply for a crisis.

Based on WHO Principles it should

  1. Deliver quality health support
  2. Be responsive, fair and efficient.
  3. Use a reliable information system
  4. Ensure equitable access to essential medicine, vaccines and quality technology
  5. Create a sound fundraising financial system to protect patients from financial catastrophe and impoverishment in lean terms and
  6. Provide strategic policy frameworks, effective oversight, regulation and accountability.

The DA supports the committee report but does not support the budget. — DA Shadow MEC for Health, Celeste Barker