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Cape Town - A fierce row has broken out between the SA Medical Association (Sama) and the Western Cape government over plans by the national Department of Health to centralise academic hospitals.
Last week, Sama welcomed the proposal by Health Minister Dr Aaron Motsoaledi to move control of South Africa’s tertiary hospitals from the provinces to the national government with the aim of increasing the number of trained doctors and improving management of these training institutions.
The doctors’ union has criticised Western Cape head of health Professor Craig Househam for his opposition to the possible transfer of Tygerberg and Groote Schuur hospitals.
Dr Phophi Ramathuba, chairwoman of Sama’s public sector doctors, said the anger displayed by Househam was driven by the fear of losing control of the funding allocated to these two hospitals, which are among 10 hospitals in the country.
Househam has said that the national department had neither the capacity nor the skills to run the two hospitals from Pretoria.
He was quoted by Business Day as saying the decision to centralise the two hospitals was a “mistake” as they were well-managed and had competent chief executive officers.
But Ramathuba said that if Tygerberg and Groote Schuur were centralised, Househam would lose not only the control of the multimillion-rand grant from the national government, but the “control to cut the number of beds and theatre time to divert funds where it is critical for his province and not (for) the country”.
Ramathuba said that Sama believed the responsibility of skills production was a national competence and that the provincial responsibility was to render services to the people of the province and focus on service delivery.
“These central hospitals have seen waiting times increase over the years and service delivery, too, has been compromised.
“The current system has failed the public in the provinces with no academic centres, as patients from these provinces (have been) seen (as) ‘exhausting budgets’ of those provinces with such centres,” she said.
Ramathuba also described the attempt to retain the two hospitals as a “political game” between the ANC and DA. She said the control of academic hospitals by provinces would “result in provinces not taking sufficient interest in research and training of health care professionals as their main priority”.
She said the national Treasury had always provided funding to these academic centres, but provinces, including the Western Cape, had often diverted this funding into provincial interests.
But Househam struck back at Sama, saying Ramathuba’s comments were “regrettable and ill-informed” regarding the hospitals in question and the role of provinces.
“The references made to my alleged fear of losing control of the two hospitals and that I have diverted funds earmarked for these hospitals is frankly untrue. Any independent audit will indicate to the contrary.
“My objection to the national decision is based on the considered view that this step ‘in the current context’ will fragment a national and provincial health system, decrease local accountability and conflate the functions of the national and provincial departments.”
Househam said that while Sama was correct in saying that the national government had a responsibility to train adequate numbers of health professionals, it was wrong in saying that the Treasury had always provided funding to these academic centres and provinces.
“The reality is that in the case of the Western Cape funds have been diverted by the national Health (Department) in the past to other provinces.”
Househam said this had resulted in a R450 million shortfall for highly specialised health services.
“This shortfall has been addressed by the diversion of provincial equitable share funding to the two hospitals in question and thus the situation is exactly the reverse of that alleged by Sama,” he said.
Motsoaledi aims to increase the number of doctors trained in South Africa from 1 200 to 3 600 a year, with medical schools having increased their intake by 160 students last year.