SA’s cash-strapped economy translates into the government spending less per person on health, with doctors’ and nurses’ posts being frozen‚ requiring permission from the Treasury and provincial leaders to be filled.
This was detailed in the South African Health Review 2017, in a chapter written by Treasury staff and health analysts‚ released on Wednesday morning.
The admission that "most provinces have imposed some form of restrictions in terms of filling vacant posts" is in stark contrast to denials earlier this year by the health minister that posts had been frozen. The review’s figures detail the dire financial situation and includes the admission that doctors and nurses can only be hired with a premier’s permission and provincial treasuries’ sign-off.
The health budget grew from 8.5% to 10% between 2009 and 2012‚ but has leveled off since then, increasing by only 1.1% in the past financial year. Staff costs rose 8% above inflation between 2006 and 2015‚ partly due to an occupation-specific dispensation — an incentive scheme to encourage rural employment.
The review shows there may even be a decline in the health budget with the spend falling from 1.3% to 2.2% between 2015 and 2019. But as spending declines‚ the costs of mostly imported medicines are rising due to the rand’s weakness and the rising number of people using the health system.
The uninsured population is now growing at 1.52% a year more than projected increases in the health budget over the next few years — meaning less is being spent per person
The response to the squeeze has been to stop building new hospitals‚ to delay maintenance, and to stop hiring staff — even when doctors and nurses resign‚ according to the review. The review reports: "Given the apparent inability of government to control personnel costs‚ limits on personnel numbers have been put in place to control expenditure."
This is a stark contrast to the denial earlier this year that posts were frozen. "We want to put it on record that there are no medical posts frozen in this country‚" said Health Minister Dr Aaron Motsoaledi in a statement. "If there is freezing of posts by government departments‚ they have nothing to do with medical doctors as posts in the health sector are exempted."
One doctor said the posts they had applied for were frozen and they had to get a job at a state hospital that was actually funded by a non-governmental organisation.
Another said the hours they work "are f*****g ridiculous and increasing year on year because the health department continues to squeeze more out of doctors instead of hiring more of us".
This week, the Democratic Nursing Organisation of SA (Denosa) blamed an incident in which a new-born died at Chris Hani Baragwanath hospital due to a shortage of nurses. It said there was a "gross shortage of nurses in health facilities throughout the province and our red flag over this long-standing issue has always fallen on deaf ears".
"The shortage of health professionals and support staff in our facilities confronts the vulnerable patients on a daily basis‚" said Denosa Gauteng provincial chairperson‚ Simphiwe Gada. "The shortage of staff at Baragwanath Hospital seriously compromises the quality of healthcare that patients receive at that facility. Bara may be a case in point‚ but the challenge is wide and affects almost every facility."
The review says shelving the plans to build hospitals has been one area where costs are saved with a decline in spending by 5.2% a year from 2012. Bambisana Hospital in the Eastern Cape was supposed to be rebuilt, but will now be renovated instead.