Unless they fight for their rights, many South Africans might be left out of the much-anticipated National Health Insurance (NHI) Fund as their public clinics and hospitals are in a dire state of neglect that might disqualify the facilities from registering with the scheme.
This is while the Department of Health has spent R67 million on the salaries of the employees of the ghost town Orsmond Tuberculosis Hospital in Kariega, in the Eastern Cape, between 2021 and the first half of 2023.
The warning about some public health facilities not meeting the minimum standards of the NHI came from newly appointed Health Ombudsman Professor Taole Mokoena, who said this week that communities would have to fight for their local clinics and hospital to improve their health-care delivery services in order to qualify to be registered with the NHI.
However, Dr Nicholas Crisp, the Health Department’s deputy director-general in charge of the NHI, said there were also private facilities that were not in compliance with NHI requirements. He said Parliament had approved R10 billion per annum for infrastructure improvement across the nine provinces.
“Yes, we all know that some institutions, public and private, are not compliant with OHSC (Office of Health Standards Compliance) standards but, like all new initiatives, there will be transition periods that allow poor performers to catch up,” said Crisp.
He attributed the poor conditions of some facilities to a lack or minimal budgets for capital improvement, poorly run capital improvement programmes for some facilities, “maintenance run by other non-health departments who are not motivated to do the work when it is necessary,” said Crisp.
According to Eastern Cape Health MEC Nomakhosazana Meth’s response to DA MPL Jane Cowley’s parliamentary questions, 28 medical and 17 non-medical staff at the Orsmond Hospital have refused to be deployed to other short-staffed health facilities and allegedly preferred to report for duty at the hospital only to sit doing nothing the whole day. The hospital was shut down in 2021 after its services were rendered non-essential.
“Employees were afforded an opportunity to choose facilities they prefer to be placed at. The process was done and completed. Forty-five (45) employees refused to be allocated as per the advice given by their respective unions,” read MEC’s written response.
The overcrowded Bramfischer Clinic in Soweto is an example of many public health facilities that are in desperate need of funds for infrastructure development and health-care equipment in order to qualify to be registered with the NHI.
According to Gauteng’s Democratic Nursing Organisation South Africa (Denosa) secretary Bongani Mazibuko, the clinic is built out of makeshift material.
“Each cubicle (consulting room) is so small you can only fit in an examination bed, a table and a chair.
“A nurse finds it hard to consult a patient because of lack of space and, worse, sometimes nurses are forced to consult two patients simultaneously and there is no privacy at all,” said Mazibuko.
Mazibuko said there were other clinics in Gauteng that have makeshift consulting rooms, but those consulting rooms were additional to proper buildings.
“Unlike in Bramfischer, where makeshifts are the only structures that exist and patients have to wait in a carport structure for treatment because there are no proper waiting rooms,” said Mazibuko.
The National Assembly on June 12 forwarded the NHI Bill to the National Council of Provinces and various provinces for further consultation before it is sent back to the Assembly for the MPs to vote on it.
But there were concerns that it might not benefit everyone, especially those whose health care relies on public health-care facilities that are in a state of neglect.
Its Section 41(4) states that for a private or public institution to qualify to receive payment from NHI for services rendered, “the Minister may make regulations to provide that payments may be made on condition that there has been compliance with quality standards of care or the achievement of specified levels of performance”.
“We know that some of the institutions have failed the occupational health and safety standard and this is an ongoing problem that still needs to be addressed,” said Mazibuko.
He said there were many other clinics and hospitals that had received some revamp, but they were still not to the minimum standard.
“In Tshwane, the Mamelodi Regional Hospital has been revamped and there is an improvement as Dr Naing Soe is doing a very good job,” said Mazibuko.
Mokoena, who recently replaced Professor Malegapuru Makgoba, said some hospitals and clinics would not meet the minimum requirement standard.
“Those (facilities) that do not comply would not access that funding.
“It would be a wake-up call for them (public facilities) to co-operate, otherwise they won’t get access to funding,” Mokoena recently told SAfm listeners.
In his previous research, Mokoena found the situation in private health care “a lot healthier than that of the public health”.
“Admittedly the public sector serves 85% of the people and, for the same amount of money, the private sector serves 15% of the people.
“There is no stable management in any of the provinces. There are acting people, and acting people are unable to make firm decisions (and) indeed the workforce does not respect them because they are acting,” he said.
Mokoena called on communities to demand changes.
“Bad health care is worse than no care at all.
“Maybe it is better that those facilities that give bad health care shut (down) than to be left cruising and giving bad health care because bad health care leads to death.
“If they are not licensed and they can’t give the health care, then it is for the population and the people around that hospital to agitate that the hospital must do right so that they can get the services,” said Mokoena.
Denosa’s chairperson in KwaZulu-Natal, Sibonelo Cele, said most clinics and hospitals in the province were not ready for the NHI as they did not have equipment, medication or sufficient staff.