The Limpopo health department has saved enough money from restructuring its staff complement to hire more specialists but is still grappling such severe personnel shortages that patients are waiting months for operations, according to its health MEC.

The delays are not only traumatic for patients,  but raise the risk of medico-legal claims against the department.

Limpopo health MEC Phophi Ramathuba is implementing a turnaround strategy that includes a massive staff overhaul. She has slashed the number of senior managerial posts in head office and moved district managers to more hands-on roles as hospital CEO positions, saving enough money to hire 26 extra specialists.

But it is far from enough to meet the demand for services, she said in an interview on Monday.

“We still have serious gaps. We need 36 more specialists, 200 medical officers, 250 professional nurses and 200 enrolled and staff nurses. We also need cleaners, groundsmen, porters, laundry assistants and switchboard operators,” she said.

The province, which is home to 5.8-million people, has just one state-employed oncologist, one paediatric oncologist and its sole neurologist works part-time.

Over 3,300 patients are on waiting lists for surgical procedures, and another 23,000 need eye operations, she said. Patients typically wait three to six months for their operations, she said. “It is not acceptable,” she said, noting that if patients had to wait months for surgery, it raised the risk of complications and meant patients were more likely to sue for damages.

Like most other provincial health departments, Limpopo faces soaring medico-legal claims from injured patients. Claims against the department more than doubled in the year to March 2018, rising to R4.875bn  in 2017/2018, from R2.2bn the year before, according to its 2017/2018 annual report.

Ramathuba’s staff restructuring strategy is an attempt to rectify an issue that the Treasury has consistently flagged as an area of concern across SA: many provinces have created bloated administrations at the expense of frontline personnel and budgets for goods and services.

She previously told Business Day that Limpopo went on a hiring spree shortly before it was placed under national administration in 2011, and appointed more than 5,000 non-core staff.

She conceded the quality of Limpopo’s public health system remained a challenge, but said there were some improvements. For example, its maternal mortality rate had improved from 140 per 100,00 live births in 2015/2016 to 108 per 100,000 live births in 2017/2018.

Ramathuba said she had implemented a policy that required hospital CEOs to report all maternal deaths to her office, and she held regular meetings with senior staff to discuss the deaths. "No CEO wants to come to my boardroom to explain what has happened."