EDITORIAL: Stop wasting energy on NHI and fix the rot

The release this week of the health ombud’s shock report into the harrowing conditions confronting pregnant women and babies at the Rahima Moosa Mother and Child Hospital came as no surprise to anyone who has had the misfortune to rely on public health services in Gauteng.

While there are undoubtedly many hard-working and committed doctors and nurses providing excellent care, the vast majority of the 16-million people who depend on the province’s public health facilities face a callous, uncaring and degrading system.

Health ombud Malegapuru Makgoba’s report into the Rahima Moosa maternity hospital has painted a picture of a once-proud institution so poorly managed that pregnant women are now forced to sleep on the floor, raw sewage runs between buildings and wards are left unheated. While patients endure these terrible conditions, senior management luxuriates in newly renovated offices.

Read between the lines and it is clear the place is rotten to the core. Investigators found CEO Nozuko Mkabayi was appointed despite disclosing a serious mental health condition that raised questions about her fitness for office and against the counsel of her referees; the probe found staff broke supply chain management rules and ensured non-compliant orders were signed when the CEO was conveniently on leave; the hospital’s security services were missing in action, with no access control in force and broken CCTV cameras; and 11 women suffered serious post-operative infections because the hospital had run out of povidone iodine — a cheap antiseptic used to sterilise the skin before and after procedures — and they were instead doused with an ineffective concoction dreamt up by the theatre manager.

Gauteng and Western Cape inherited similar resources from apartheid SA — large tertiary hospitals offering specialist services, world-class medical schools and some of the country’s best doctors. Almost 30 years later, health services in Gauteng are in terminal decline, while those in Western Cape function more or less as they should.

Gauteng can rightfully claim that as the country’s economic heartland, it has seen huge migration into the province and soaring demand for services without a commensurate increase in its health budget. But so too has the Western Cape.

There are many reasons why they operate so differently, but one of the most important ones is the fact that Western Cape has maintained a stable management team, while in Gauteng it is rare for a head of department or MEC to last more than a year.  Public health systems are phenomenally complex and require leaders with vision and experienced officials capable of crafting and implementing plans: a revolving door at head office undermines all of that.

Today the decay is manifest throughout Gauteng: Charlotte Maxeke Johannesburg Academic Hospital is still not operating at full tilt two years after an arsonist set it on fire; whistle-blower Babita Deokaran lost her life for flagging millions of rand of suspicious payments flowing through Tembisa Hospital; and just last week the province’s security services stood idle as striking members of the National Education Health and Allied Workers Union blockaded hospitals and placed patients’ lives in jeopardy.

Given that two previous investigation reports into the Rahima Moosa maternity hospital were shelved, there is faint hope that Makgoba’s recommendations will result in anything more than cosmetic changes. While his advice to move the CEO to head office and support her efforts to get well is easy enough to implement, his recommendation for a forensic audit and a rapid refurbishment of the facility require a level of leadership and political will that is entirely lacking.

The stock response from the government when presented with this catastrophic state of affairs is that there is not enough money in the health budget. And therefore, the argument goes, the financing reforms proposed under National Health Insurance (NHI) will fix it all. That is naive at best, and dishonest at worst.

No health budget is ever enough. No budget is so small that the most basic items required to run a hospital cannot be purchased. This is not an underfunding problem and NHI is not going to fix the corruption and indifference running through the veins of the Gauteng health department.

Public health in Gauteng has collapsed. It is time to stop wasting energy on NHI and fix the rot. For that President Cyril Ramaphosa needs to make good on his promises to stamp out corruption and clean up Gauteng.