Nkosikhulule Nyembezi
Cape Town - Here is another public service announcement: if you are one of the millions of people who rely on the public health system, do not have a heart attack or stroke, and do not catch the flu or get involved in a vehicle crash.
The chances are that no one will arrive in an ambulance to help you, and you will not receive proper and prompt medical attention in dysfunctional hospitals and clinics.
The health service heads deep into winter. The flu is spreading. Shack fires are increasing, botched circumcision cases are looming, an exhausted and demoralised workforce is struggling to cope, severe staffing shortages persist and a broken social-care system needs reform.
Unbelievable as it might sound, the warning is not new to those served by the public health services as nothing significant has happened in response to the recommendations by former health ombudsman Professor Malegapuru Makgoba, who described the South African health system as “dysfunctional” and “a mess”.
It is not a one-off scenario. The community health forums and legal advice centres continue to receive regular complaints from people about poor health-care services. An adequately funded workforce plan is required.
The failure of national and provincial health budget votes to direct the available funds to address the urgent administrative and operational challenges compounds the neglect. It echoes Makgoba’s sentiments at the end of his seven-year term on May 31, that the health system in most parts of the country is not working, and the government is unwilling to fix it.
Makgoba named the Eastern Cape and Gauteng as the provinces with the most dysfunctional health departments, while the Free State is not far off the two.
The common thread in the Eastern Cape and Gauteng public health sector is the lack of leadership, constant change of CEOs and disorder. Makgoba found the Western Cape has managed to get its house in order over the years.
It is hard to imagine voters being dazzled by a promise that the introduction of the National Health Insurance plan will enable clinics and hospitals to attend to the comprehensive needs of patients – more than 12 years after the ANC government pledged it.
What is needed is more doctors, not more targets. Yet the budget vote debates gave no assurance to citizens, probably because it would come with a price tag that the Treasury would baulk at.
Pusillanimity will not help patients who need chronic medications, or the youth needing user-friendly services.
The lack of medication, due to corruption and maladministration, also endangers lives. Hundreds of people on waiting lists for potentially lifesaving care have been waiting for more than four months. That means putting people at risk of becoming disabled or dying because there are no medical supplies and insufficient doctors, nurses and physiologists.
Politicians participating in the budget vote debates tried to blame the collapse in the service on the coronavirus pandemic. But the public is not buying it.
More than half of complaints in community health forums and community legal advice centres nationwide in the past two months said record ambulance waiting times and the unavailability of medical staff and medication were the government’s fault.
The complaints point to a problem: the average ambulance response time to severe condition calls has increased to more than the government’s target.
More people wait almost an hour and a half, if they are lucky.
It is a symptom of the social care crisis that most people endure – one that the Ramaphosa administration promised to solve – that too many people cannot access health services.
Ambulance staff become demoralised queueing outside hospitals, unable to answer emergency calls due to broken vehicles and unreplenished emergency medical kits and oxygen tanks.
The storm has been brewing for a decade. Austerity and corruption have shrunk hospitals and clinics so much that they cannot provide basic medical care to everyone in the waiting area.
Community care services are too shrivelled to help.
The upshot is patients wait in pain for even longer on hospital and clinic benches after waiting too long for help to reach them. By next year, when the next election is due, the number of unfilled posts could remain high if the administrative bungling continues to occur under the watch of corrupt politicians and officials.
A deteriorating public health system crisis will damage the ANC’s credibility.
On Cyril Ramaphosa’s arrival in the Union Buildings, many voters compared the government to a sewer blocked by a fatberg of sleaze due to corruption and incompetence endured during his predecessor’s tenure.
His job was to clean it. The ANC factions had emptied virtually all the experience and ability out of the government. Senior ANC deployees littered the drains.
The ANC, as a whole, faced an inquiry into state capture. Question marks hovered over irregular awarding of Covid-19 PPE contracts and what else? As for Ramaphosa, he was as near-saintly as could be. He coated the doors of Mahlambandlovu with “New Dawn, Thuma Mina, and Ramaphoria” and went to the ANC renewal programme. The trouble was that the toxicity of corrupt cadres deployment entitlements enthralled the ANC in the government.
In these challenging times, Ramaphosa’s administration needs political will to implement plans to address patient needs, adopted in consultation with stakeholders rather than excuses.
This bold approach means coming up with solutions – and convincing the Treasury that more cash is needed – to restore competence and deal with the emergency. As enough voters realise the public health-care system is on its knees, Ramaphosa’s ambition for a second term may be in trouble.
The theatre of factional ANC politics has distanced itself ever further from the serious business of the government. Its appetite for heroes and villains has become insatiable. Ramaphosa may be in trouble for failing to keep his election promises. The president faces a brutal economic outlook.
But make no mistake, a chill sets in for the public health service.
Nyembezi is a research, policy analyst and human rights activist
Cape Times