Public Protector reports on problems plaguing the public health sector and poverty eradication efforts

Policy gaps, management inefficiencies, administrative problems, fragmented decision-making and aging infrastructure were some of the challenges that may be undermining efforts to improve the country’s public health system, Public Protector Adv. Thuli Madonsela said on Thursday.

She was addressing lawmakers at the Free State Provincial Legislature on her observations following a tour of the province and the country, in a speech that marked the end of her two-month National Stakeholder Dialogue.
The dialogue focused on strengthening government's ability to deliver on the Millennium Development Goals, placing special emphasis on improving healthcare services and eradicating poverty.

Accompanied by her Deputy, Adv Kevin Malunga, the Public Protector told the provincial parliamentarians that, during her interactions with communities and on surprise visits to nearly 20 public health care facilities, she observed that other issues that undermined the provision of quality healthcare services were issues beyond the health sector.

While noting the good strides that government has made in the provision of quality health care, particular on the HIV/AIDS programme, and the planned National Health Insurance, the Public Protector highlighted a few limitations she picked up during the dialogue. She said dialogue sought to complement the good work that was already being done by the Department of Health and enriching the systemic investigations that she was conducting in relation to health matters.
She congratulated the Free State government on its report that it had registered a 43 percent reduction of maternal deaths. The Public Protector also commended the Bloemfontein National Hospital on its report that it hasn’t had a maternal death in the last four years and that it had only one infant death in the last 12 months.

On policy gaps, the Public Protector indicated that while the grading of hospitals into primary and tertiary facilities was a good idea, the model needed to be reconsidered in respect of areas where the facilities were far apart.

For hospitals that were not far from each other, she explained, it was not risky to refer emergency patients. It was, however, a different story for patients that had to be referred to faraway hospitals as this exacerbated their conditions, leaving them extremely distressed by the time they reached the next hospitals.

This had been observed in a number of provinces, including the Northern Cape and Limpopo, where facilities that did not have theatres to conduct lifesaving operations such as the caesarean procedure for women who were in labour, had to refer such patients to other hospitals more than 200km away.

“It is a good idea but it presupposes that these facilities will be in close proximity to each other,” said the Public Protector. “The Bloemfontein National Hospital, for example, told us that it has had zero maternal deaths for the last four years and one infant death in the last 12 months. When an emergency occurs they are able to send the sick to another centre in ten minutes. But rural communities have a different experience and that is where deaths usually occur.”
She said the inability of primary health care centres to perform minor operations impacted negatively on high level care centres because people bypassed local clinics and went direct to tertiary hospitals, leaving them over crowded thereby slowing down the pace of service. Doctors themselves believe certain services should be available at lower level hospitals, the Public Protector said.

Other policy issues included the need to standardize the remunerations community health care givers, which seemed to differ from one province to the other. In addition, the care givers, whom the Public Protector said were shouldering part of the country’s health care burden, often had to work without important surgical consumables such as gloves, diapers, antiseptic solutions and health ointment. They also had to travel long distances at own expense to visit and care for patients at the patients’ own homes. There were also issues surrounding ambulance response times and other patient transport services.

Regarding administration problems, the management of the facilities emerged as a source for concern. Although some facilities had managers who appeared in control and competent, others had managers who were found wanting when they had to account for unclean surroundings, unfilled vacancies, and MDGs statistics and monitoring.
Human behaviour including rude staff and unprofessional conduct by staff, which spends little time with patients and misdiagnose them, also emerged as big issues in some of the facilities, the Public Protector said.

“Where we went this morning the question of human behaviour was a big issue. A patient cried, indicating that if she were to be treated that way by people who were young enough her children, she’d rather die, indicated that if she were to be treated that way by youngsters she’d rather died,” she said referring to the MUCPP Clinic outside Bloemfontein.
Outsourcing of goods and services, management of equipment, including replacing and servicing, operating hours and daily intake of patients from clinics, and patient nutrition were also observed as management issues that needed to be given urgent attention.

In respect of multiple level decision-making, the Public Protector referred to problems with delegations of power to hire and fire staff and procurement threshold to allow facility managers to be able to acquire important equipment as and when needed. There was also a need to standardize norms in terms of infrastructure.

On poverty, the Public Protector noted government reports that more than 52.3 percent of the population still live below the poverty line of R577. She said it had been reported the figure was 58 percent for the Free State. The Public Protector noted that the province appeared to have no integrated poverty eradication strategy covering all dimensions. No targets or milestones were shared. She, however, indicated that this appeared to be the case in other provinces.
The Public Protector has already received undertakings from authorities in all provinces to resolve some of the issues they conceded. She will monitor implementation in this regard. Comprehensive reports on her observations will be issued to the respective provinces and to the central government. Complex matters will be investigated.

For more information, contact:

Kgalalelo Masibi
Spokesperson
Public Protector South Africa
012 366 7006
079 507 0399
kgalalelom@pprotect.org
www.publicprotector.org
0800 11 20 40