Limpopo’s cancer patients are waiting, on average, for a year before they can get vital radiation therapy, a sign of the immense pressure facing the province’s health department, Parliament heard on Wednesday.

In a frank presentation to Parliament’s health portfolio committee, Limpopo health MEC Poppy Ramathuba described how chronic budget pressures, staff shortages, and dilapidated equipment were compromising patient care.

The Limpopo health department received a qualified audit from the Auditor-General in 2016-17, despite reductions in its wasteful and irregular expenditure. It began the 2018-19 fiscal year with accruals of R1.09bn and R739m in outstanding employee benefits, against a budget allocation of R19.5bn for the period.

About 40% of the accruals were due to over-spending on the R863m budget allocation for medicines in 2017-18, due in part to a sudden surge in the price of some essential medicines, said Ramathuba. For example, the price of the malaria drug artesunate more than doubled from R160 a vial in April 2017 to R360 in October 2017.

Like most other provincial health departments, Limpopo faces massive medico-legal claims for harm allegedly suffered by patients at its hands, largely for cerebral palsy and orthopaedic cases. It paid out R28m for eight successful claims against it in 2017-18, and faces a further 796 claims totaling R4.35bn.

The health portfolio committee has asked all nine health MECs to appear before it and describe the state of hospital services in their provinces. The Western Cape, Eastern Cape, Gauteng, Mpumalanga and the Northern Cape preceded Limpopo, and all described growing service pressures.

Public-private partnership

Ramathoba said Limpopo had already entered into a public-private partnership to provide dialysis services and was about to do the same for radiation therapy. The current cancer patient backlog was partly due to the department having only one functioning linear accelerator, and it was so out-dated it could only treat 25 patients a day, she said.

Earlier in the day, a delegation from the Northern Cape described how its struggle to fill specialist posts was threatening its capacity to provide care. Northern Cape head of health Steven Jonkers said the department faced more than R1.4bn in medico-legal claims. Many of these clams related to cerebral palsy cases, some of which date back to 2004.

These cases reflect weaknesses across the province’s health system, which has only one tertiary facility — Kimberley Hospital — to which all complicated pregnancy cases are referred, said its medical director Dion Thys. "Take a lack of skills, late presentation at ante-natal clinics, add long distances, and you have a lot of snow-balling issues," he said on the sidelines of the meeting.

Thys told MPs that the provincial health department employed just 30 specialists, 27 of which were at Kimberley Hospital. However, Kimberly Hospital was struggling to recruit a specialist to head its obstetrics and gynaecology unit, he said. "The services are there, there are experienced medical officers in the unit, babies are born, operations are done — but we lack a lead person in the department."

Thys said the Northern Cape lacked many key specialists, such as nephrologists and cardiologists. However, it was able to provide appropriate cancer services as it had two oncologists, two radiologists and one pediatric oncologist.

Kimberley Hospital was "bursting at the seams" and patients faced long waiting times, he said, adding that the department had tried to reduce the number of patients at the facility by moving some orthopaedic surgery cases to Uppington Hospital.

The Northern Cape health department received a qualified audit in 2016-17, and has significant financial management challenges. MPs heard that it started the 2018-19 fiscal year with R532.6m in accruals, reflecting unpaid bills from prior years. Its allocated budget for the 2018-19 fiscal year is R4.74bn.