Eastern Cape rural health is on the brink of collapse as a moratorium on the appointment of doctors and nurses is leading to clinics and hospitals having to shoulder the burden of delivering healthcare without staff.
Concerned groups have called on the national health department and treasury to intervene or face disaster in a matter of weeks. The list of problems facing the province’s beleaguered health system is long.
Earlier this week the South African Medical Association (SAMA) revealed that it was aware of at least 30 doctors who had not been paid since December.
Outreach services, whereby doctors and allied health professionals travel to outlying clinics and hospitals, are grinding to a halt as the transport system is no longer available and doctors are no longer prepared to use their own vehicles and fuel to travel long distances on inaccessible roads.
The Eastern Cape Health Department is failing to place community service doctors in areas where the need is huge with most doctors ending up in the big urban hospitals while rural hospitals in many cases receive no doctors. Community service doctors are a critical part of delivering health care to these far-flung areas.
In rural areas, nurses retire and are not replaced, leading to longer waiting times and burn out. Health Minister Dr Aaron Motsoaledi has on several occasions stated that retired nurses would be called on to assist with the transformation of the health system with advertisements being placed. However, in several Eastern Cape clinics the opposite is happening, despite the fact that it is often impossible to find young nurses prepared to work in these areas.
In one busy rural clinic the nurse complement will from six to two professional nurses by June, with the two remaining nurses showing signs of burn-out. Two of the retired nurses have indicated that they are available to continue working, but the provincial health department has failed to respond.
“This specific clinic is notoriously difficult to staff due to its rural location and no nursing accommodation available. The irony is that at a time when this clinic is floundering, two highly competent and keen nurses who live locally are forced to sit at home,” said Dr Madeleine Muller, Rural Doctors Association of SA Eastern Cape representative.
Dr Anthea Klopper, chairperson of SAMA’s Border branch said they were aware of five doctors within the East London Hospital Complex who may have no posts and will be forced to look for employment in other provinces. “This at a time where we are critically short of staff,” she said. “Posturing, blustering, shifting the blame and ignoring the problem have continued for too long.”
In a hard-hitting statement released yesterday (17 May), Rudasa and a group of health organisations said: “The loss of one or two doctors or a single pharmacist from a rural hospital team can turn working conditions from challenging to completely unmanageable for those who remain. Once rural healthcare teams disintegrate, retention of remaining staff becomes impossible and rebuilding these teams is virtually unattainable. Ultimately, the rural poor, who live in communities where healthcare delivery is already patchy, suffer even more.”
The group, which includes the Rural Health Advocacy Project, SECTION27, the Treatment Action Campaign, Africa Health Placements and the Budget Expenditure Monitoring Forum (BEMF) said it understood that part of the problem was due to Treasury trying to control costs within the Eastern Cape Health Department, focusing on staffing, as salaries are the main driver of overspending.
“However, we believe that there is little understanding by Treasury of the impact that their austerity measures is having on the healthcare of poor South Africans,” the group said.
It is widely known that a moratorium in practice, but not in name, has been placed on new appointments. “This is like using a sledgehammer to destroy a cancer when a scalpel is needed,” the group said.
It warned that the collateral damage to the health system, particularly in rural areas, would be devastating and would undermine preparations for National Health Insurance in the OR Tambo health district, one of the areas most affected by the non-payment of staff.
A health worker in OR Tambo district said: “After working for 4½ months without pay, our dentist left us. He no longer believes that he’ll get paid. I am amazed that he lasted this long. Major disaster is looming in the Eastern Cape unless the budget impasse can be sorted out. He was the only dentist for more than 100 000 rural people.”
The group called on the national Health Department and Treasury to intervene. “If this does not happen, we shall be facing a healthcare disaster in the Eastern Cape within a matter of weeks,” they warned.
“They have a Constitutional obligation to intervene as the provincial Department has demonstrated that they are unable to resolve the crisis on their own,” said Daygan Eagar of the BEMF.
Eastern Cape Director-General Dr Siva Pillay and Motsoaledi’s spokesperson Fidel Hadebe could not be reached for comment at the time of going to press.
by Anso Thom
View this article on the Health-e News website.