Health on life support

Public health in the ANC-led province of the Eastern Cape is on the verge of collapse, with thousands of patients being treated in condemned hospitals.

Shocking details of how the province's sick are cared for in hundreds of sub-standard buildings that have no running water, electricity or essential drugs and critical staff shortages were revealed in parliament yesterday.

Preliminary findings of a high-level audit by the national Health Department found that most health facilities in the Eastern Cape would close down once the Norms and Standards Bill, governing the standards of health facilities, becomes law.

Senior officials from the Eastern Cape health department yesterday painted a grim picture on the crisis that has crippled the provision of healthcare in that province.

Eastern Cape health Superintendent-General Dr Siva Pillay said the province is faced with a R20-billion infrastructure backlog and would n be unable to meet norms and standards set by the national department of health for the effective functioning of health institutions.

Pillay revealed how:

• Six health institutions have been condemned but are still operating out of necessity;
• 168 clinics and 17 hospitals lack piped water;
• More than 42 health facilities do not have electricity and operate via generators;
• 68% of hospitals do not have essential medical equipment; and
• 16% of facilities do not have telephones and some are not accessible by road in bad weather.

The worst are Elizabeth Donkin Psychiatric Hospital in Port Elizabeth; Nessie Knight Hospital in rural Qumbu and Isilimela Hospital in Port St Johns.

Pillay said it had a vacancy rate of 46% - mostly essential clinical staff - and would need another R9-billion to hire the required staff. It could not afford the salaries for trained clinical personnel.

"The whole budget becomes almost a joke," said Pillay.

He said none of the province's institutions could meet industry norms and standards.

"Most of our buildings are not structurally sound to provide services and yet they continue to receive patients," Pillay said.

With a R20-billion infrastructure backlog, the R1.1-billion allocated by the Treasury to the province this financial year towards improving infrastructure would merely "plaster the cracks". The province expects this backlog to escalate to around R26-billion.

Support services were also in a dire state, he said.

The department was also embroiled in a number of court cases involving the alleged contamination of water sources as a result of poor sanitation at some facilities.

Pillay said 26% of the budget was going to infrastructure development, operations and maintenance despite this being a local government function.

For maintenance, just over R1-billion was needed, but only R150-million had been allocated, he said.

For equipment, R1.2-billion was needed. Currently there are 856 clinics, 66 hospitals, 17 specialised hospitals, three regional hospitals and seven hospitals which were housed in three complexes.

MPs acknowledged the magnitude of the crisis and agreed healthcare was on the verge of collapse.

In contrast, the DA-led Western Cape reported that its health infrastructure-spending plans remained on track, while more than 80% of its hospitals met national standards on cleanliness, safety and the stocking of medicines.

Western Cape health MEC Theuns Botha said spending on the hospital revitalisation programme remained on track and that its budget was in order.

He was confident of meeting the national norms and standards requirements.

To date, of the 13 hospitals identified in the revitalisation plan, construction was completed at four while another four were nearing completion. Another five were in the planning phase at a cost of just under a R1-billion.

Botha, however, admitted that it was not all smooth sailing as there were problems in the provision of primary healthcare.

He said there was a maintenance backlog, which would require an additional R800-million to clear.

"We haven't got that kind of money so we've established a health foundation fund, a totally separate individual structure.

"Its only aim is to drive projects for the department with an emphasis on maintenance," Botha told parliamentarians.

He said the province fell short of 4000 nurses to reach its ideal staff component of 34000.

"We haven't done enough, you're right... [but] we have a primary healthcare system in this province," Botha said.

Among some of the problems experienced by the Western Cape were delays in rolling out digital radiology, outstanding construction work at George Hospital and a protracted legal battle with a contractor at Worcester Hospital over substandard work.

Botha also said 50% of the province's facilities did not comply with minimum waiting times.

According to preliminary baseline reports on national compliance to standards:

• 82% of hospitals and 30% of clinics met the cleanliness standards;
• 89% of hospitals and 38% of clinics complied with safety and security standards; and
• 88% of hospitals and 45% of clinics met the national minimum for stocking levels of vital tracer medicines.