Debate On Vote 7: Health Budget

By Hon N J Nkwanyana MPL

Hon Speaker,

The Inkatha Freedom Party has noted the Budget allocation of R39.5 billion mentioned by the MEC of Health, Dr Sbongiseni Dhlomo, but it is the view of the IFP that this amount is grossly inadequate to meet the spending challenges faced by this department. It is common knowledge that this department over spends its budget every year and seems to getting itself deeper into debt. Financial mismanagement has plagued this department for far too long and if stringent measures are not put in place to curb wasteful expenditure and shortcomings at the supply chain management level, the Department of Health will continue to fail our people in terms of providing adequate health care.

This department seems to have a vision on paper which it fails to implement and as a result our people at the receiving end of poor service delivery.

The DoH is facing a crisis on many levels when one considers shortcomings in administration, a lack of sufficient health care professionals, shortages in the supply of certain medication, failing hospital infrastructure due to a lack of adequate maintenance, to name just a few.

The Department of Health receives the second largest share of the provincial budget after the Department of Education. If this department is prudent about its spending and is able to manage its finances better, it will be able to meet its obligations.

Of major concern to the IFP is the critical shortage of health care professionals at state hospitals and clinics. Keeping in mind that 87% of the people of this province do not have health insurance, the department has to address this issue as a matter of urgency.

The situation in rural areas is even worse as people have to travel long distances often over difficult terrain to receive medical attention from clinics and this costs them time and money which they cannot afford.

The Department needs to do all within its power to reduce the amount of money that is spent on purchasing services from private hospitals. If the public sector has its house in order and is providing adequate health care services in well-equipped hospitals, there will be no need to waste money on buying services such as oncology services from private hospitals. As the IFP we hope that this is not another scam to syphon state funds into private hands by officials working within the department. This really is wasteful expenditure and the IFP would like the MEC to tell this House how much has been spent on buying services from private hospitals over the past financial year.

Professional nurses play a vital role in the provision of health care globally. The performance of health care workers, including professional nurses, link closely to the productivity and quality of care provision within health care organisations. It was important to identify factors influencing the performance of professional nurses if the quality of health care delivery is to improve. The quality, efficiency and equity of services depend on the availability of skilled, competent health professionals when and where they are needed. Health care workers need appropriate training to deliver the required standard of services.

Since a huge amount of the budget is spent on personnel costs factors affecting the performance of nurses in KwaZulu-Natal need to be examined. There is a need to seek evidence about nurses’ performance and to develop strategies to monitor and improve their performance. DoH is supposed to ensure performance of a high standard by employees, or put measures in place to detect and rectify poor performance of front-line health care workers who are in contact with patients and the community.

Madam Speaker, I sincerely believe that we have serious problems in terms of mental health and substance abuse in our Province. We have not reached a stage where we can comfortably say that we know the status of mental health in our communities because we have no way of knowing the true extent of mental illness or substance abuse unless we see patients in our facilities with these problems. The budget needs to cater not only for the treatment of mental health patients but also for the provision of suitable care facilities for such patients.

Whilst the Department continually strives towards the improvement of health infrastructure, the condition of many of our health facilities are challenged with ageing infrastructure. The need to refurbish existing facilities and build new facilities is ever increasing. As the IFP we do not see any urgency on the part of the department to do something about the backlog or to increase the budget for infrastructure maintenance. Existing infrastructure needs to be maintained and it would be financially prudent to spend funds on maintenance rather than to incur huge expenses in replacing infrastructure.

This applies not only to buildings. It includes equipment like X-ray machines, CT scanners and other vital diagnostic and treatment apparatus. The Health Department is just denying the fact that there is a major healthcare problem within the province. These problems didn’t develop overnight. They developed over years of neglect, intentional neglect on the part of this government. We are calling on the province to immediately release a public prioritized infrastructure project list.

Madame Speaker, as the IFP we are very concerned about the following issues which the MEC has failed to provide suitable answers for since last year. Therefore can the Hon MEC provide answers on what happened to the following matters:

1. The inquiry headed by Professor Fikile Ndaki, who was appointed by former Premier Senzo Mchunu in December 2014 following allegations of corruption and mismanagement levelled by the National Education, Health and Allied Workers Union (Nehawu) against former HOD, Dr Sibongile Zungu.

2. The information related to a tender that saw the department lease a truck and trailer mobile clinic for R52m. We have repeatedly asked the MEC to share this information with us. Yet no answers have been forthcoming.

As the IFP we are happy to see that there is an allocation of R475million for the purchase of medical equipment including CT scanners and x-ray machines. In view of the many non-functioning equipment at many hospitals, we hope that this money will be spent wisely in the interest of patients and will not be squandered by unscrupulous officials and tenderpreneurs.

The IFP is pleased that the Office of Health Standards Compliance (OHSC) found that the uMzinyathi and uMgungundlovu Districts were rated among the top three districts nationally. We want to urge the department to replicate the good practice in these districts into other districts in the province.

The Finance MEC announced in her Budget Speech that there is an amount of R147million which is allocated for the purchase of replacement vehicles including ambulances. The MEC for Health must tell this House what has happened to the fleet of vehicles that were purchased and left standing for years at Jacobs south of Durban. Those vehicles were intended to be equipped and added to the ambulance fleet in the province.

The IFP was astounded to hear that there is a syndicate that is operating in Newcastle in collaboration with health department officials to strip parts from ambulances and sell them to taxi operators. We commend the police for arresting those involved but want to know from the MEC what action will be taken against the employees of the department who are involved in this crime.

In his speech the MEC said that one of the important factors in reducing communicable diseases is the availability of clean portable water. While the MEC acknowledges this, there are hospitals such as the Murchison Hospital in Port Shepstone that is being negatively affected, sometimes for days, because of unreliable water supply. This is a potentially dangerous situation that impacts negatively on the provision of optimal health care services. The Department needs to address this situation if it serious about caring for our people.

In 2009 the KZN Dept of Health launched the “Make Me Look Like a Hospital” project, which aimed to contribute to the quality of care in line with the National Core Standards, but our provincial hospitals are nowhere near achieving those standards but patients are denied medical care and are sent home to die. The MEC must address the issue of attitude in our hospitals. A change of attitude among his workforce must be one of his priorities. In our hospitals we need staff who are guided by professional and organisational ethics that are based on our values as a people.

A huge concern is practitioners who are losing that human touch of putting patients first and caring for them. There are negative attitudes and health practitioners don’t have time and they don’t understand the process of communication. This is largely due to doctors having to work extra-long shifts and end up exhausted. The 2017/2018 budget needs to do more to address the shortage of doctors at public hospitals. Patients in general feel that they are not being adequately cared for.

Honourable Madame Speaker, improving and harmonising quality and safety in medical services across KwaZulu-Natal directly contributes to the South Africa’s health objectives of delivering improved healthcare quality and patient safety. A sharp increase in the number of firms seeking after-the-event insurance cover for handling medical negligence claims is prompting concerns.

The department’s budget is under pressure due to the number of huge medical court challenges. Instead of paying out huge amounts for medical negligence, it would be far better for our hospitals to ensure that patients are healed, rather than damaged by avoidable mistakes. We are aware that some hospital chief executives are not doing anything to safeguard the welfare of patients but instead deliberately jeopardise the welfare of patients and immediately report to the lawyers of these syndicates to start litigation.

The freezing of medical and nursing posts affects service delivery, deepens staff shortages, and prevents staff retention and professional development. The Honourable MEC is faced with a daunting task of turning around the Titanic of a public health system. The general public has to feel confident about using our health institutions.

Madame Speaker, better health governance is most meaningful to the most poor and marginalised, who are not covered by medical aids and lack the resources to access private health care. Like the rest of us, they deserve the best. Instead, the solution lies in getting the provincial health department working adequately, and then instituting better planning, better budgeting and better allocation of finances for medicines, equipment, staff and infrastructure. This will go a long way in making KZN healthy so that our people can use their talents, follow their dreams and care for their families.

3 universal problems hospitals need to solve

1. Medication reconciliation. This is being certain about what the patient’s correct medications should be, and is both a problem on admission and upon discharge. Not knowing the patient’s correct medications when they are first diagnosed can naturally start off a chain of events that leads to adverse medical outcomes. The same applies to when a patient is discharged, when any medications changes it must be made clear to dispensing staff.

2. Dealing with patients’ most basic complaints. Nowadays, hospitals and health care organizations are using too many gimmicks when it comes to improving patient satisfaction and enhancing the patient’s experience.

3. Discharge. The discharge process is fraught with potential problems by its very nature. It needs to be as thorough and flawless as possible. Medication need to be checked and double checked, and all follow-up instructions should be made crystal clear. Either way, the patient and family need to know the exact diagnosis and plan. This goes a long way to helping reduce readmissions and keeping the patient on a healthier path for the future. Having a good amount of time with the doctor sitting down with the patient and family immediately prior to discharge is also something to strive for.

Dinangwe ngiye ngathuka kwaphela nasozwaneni uma ngizwa izindaba zokuthi omunye wesilisa wase-Harding oshaywe imamba uye wadlula emhlabeni ngoba isibhedlela singenawo umuthi wokubhekana nobuthi bezinyoka eziyingozi njengemamba. Lokhu kuchaza ngokusobala ukuthi baningi abantu abasazolahlekelwa izimpilo ngenxa yokwentuleka kwezibiba ezibhedlela. Umbuzo enginawo kuwe Dinangwe ukuthi yini eyenza ukuthi loluhlobo lwesibiba lungabikhona ezibhedlela? Ngabe uzimisele ukuyixazulula kanjani lenkinga ezibhedlela zomphakathi ngoba lesimo sibeka engcupheni izimpilo zabantu basemakhaya lapho kugcwele khona izinyoka eziyingozi?

As the IFP we call on the Office of Health Standards Compliance (OHSC) which was officially established in 2013 as one of government’s weapons against dysfunctional health facilities to monitor and enforce norms and standards in all health facilities, including private hospitals in our province.

Drastic changes are needed within this department and our health care system if the aim of promoting the health of all of our citizens is to be reached.

I thank you