According to a 2019 report by the South African Medical Journal, the healthcare system in the country is already under strain, mostly because of poor financial management, unequal resource allocation, a double burden of disease, and load shedding.
Statistics South Africa estimates that there are more than 3 000 state-run clinics and 420 state-run hospitals operating throughout the country.
Smaller healthcare facilities, especially primary healthcare clinics, are frequently left in the dark, even though commercial facilities and secondary- and tertiary-level state hospitals appear to be well supplied with generator banks.
During a media briefing in September last year, Health Minister Dr. Joe Phaahla said his department intended to introduce direct feed-in lines to certain hospitals in conjunction with municipalities The national department of health has given Eskom a total of 213 hospitals to take into account for potential exclusion from load shedding as of October 2022.
In a statement, Phaahla said "approximately 67% of these hospitals are supplied by municipalities, whereas around 33% of the recognized hospitals are supplied by Eskom". Among the 213 hospitals, 76 have been exempted, "of which 50 are municipalities and 26 are directly supplied by Eskom," Phaahla added.
While 76 public hospitals have already been formally spared from further load shedding, and there are plans to increase that number to 300, it appears that private healthcare facilities will have to handle the ongoing issue on their own. This is true even though they face many of the same difficulties that ongoing extended rolling blackouts present for public institutions.
Kobus Jonck, the general manager of infrastructure for Mediclinic Southern Africa, says the infrastructure already in place in all Mediclinics throughout South Africa contains "a minimum of two generators that may be bus-coupled to enable the non-essential generator to back up the important load in the event that the essential generator fails during a mains power failure. Critical life support systems that demand continuous power are connected to UPS systems in addition to the generators".
Notwithstanding Eskom's load shedding, Dr. Caroline Corbett, president of the SA Anesthesiologists Association, said in a BizNews interview that rural areas frequently had power outages because of cable theft and sub station problems. As a result, major hospitals experienced patient overcrowding and poor health care.
Corbett used the example of a small child she anaesthetised for the surgical insertion and testing of a hearing device to illustrate how serious the problem has been. The procedure was planned to take place between power failures, but at the most critical point, load shedding unexpectedly increased from stage three to stage six, requiring the team to cancel the procedure, revive the child, and reschedule. The delicate testing apparatus had significant damage.
There are countless difficulties that both public and private hospitals must overcome. Dr. Wimpie Odendaal, a renowned bariatric surgeon in the Western Cape, described to Business Tech how a total blackout at Netcare in Blouberg, Western Cape, had an impact on patients who needed access to life-saving medical care. "Even with our four generators running continuously, we'd run for three to five days, keeping patients alive on ventilators, and then it would stop functioning normally,“ he said.
It is very possible for doctors working in the private sector to be unable to provide for their patients' needs and to make a living. For a single deep rural district hospital, Madwaleni in the Eastern Cape, to run two generators, diesel expenses alone range from R1 million per year to several millions of rands for a sophisticated private urban hospital (excluding generator maintenance and repair).
Jonck says "solar energy on its own cannot supply the complete load of a hospital, and so cannot replace a dependency on electricity supplies". Alternative, renewable energy sources can be expensive.
André Nortjé, the national environmental sustainability manager at Netcare, is pleased that his organisation currently has the second-largest installed base of solar power systems in South Africa among private and commercial businesses.
"Last year alone, our environmental sustainability projects provided additional yearly electricity savings of more than R21 million, while also lowering Netcare's dependence on fossil fuels and the national power system," says Jacques du Plessis, managing director of Netcare's hospital division.
The department of health predicts that solar energy will soon take precedence in places like theatres, intensive care units, and buildings with high-tech and sophisticated machinery.
“Load shedding compels us that in future when we construct new facilities, we must revise our plans and costs to include new sources of energy over and above generators. In addition, we must ensure the installation of the dedicated feeder line to avoid the current exercise of reconfiguring the electricity networks,” Minister Phaahla said.
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