Six years after the Life Esidimeni tragedy unfolded in Gauteng, an inquest into the circumstances under which more than 1 000 psychiatric patients were moved into the care of non-governmental organisations (NGOs) and about 144 died, is set to start in the Pretoria High Court next month.
Meanwhile, some NGOs that provide mental health services and activists maintain that the Gauteng health department is still short-changing such institutions and that systemic challenges remain.
One such challenge surfaced earlier this year with late payments to more than 100 NGOs housing and providing care for mental health patients.
Jack Bloom, DA member of the provincial legislature, sounded the alarm over these late payments by the department. “Towards the end of the financial year which ends on March 31, there is always a ‘dry season’ because the [Gauteng] department of health is short of funds and it carries over to the new year,” said Bloom.
He said another problem was the delay in signing new service level agreements with the NGOs.
“It boils down to inefficiency and insensitivity to NGOs who constantly struggle with cash flow problems. Unreasonable demands are made in the service level agreements, including unnecessary and expensive technical issues,” he said. “It is disappointing that the Life Esidimeni tragedy has not led to a constructive relationship with mental health NGOs.”
‘LIKE LENDING GOVERNMENT MONEY’
Lee-Ann Scholtz, the manager of Ebenezer Psychiatric Home in Roodepoort, on the West Rand, told Spotlight that these late payments by government affected how NGOs render services to the users.
According to Scholtz, government sets many stipulations that NGOs have to follow. “It’s very easy to do all these when you have money. But when you don’t have money, it becomes very difficult because you have to look after patient’s well-being by making sure they have a home, a bed, and have food on the table,” she said.
“So, when government doesn’t pay you, the food obviously is a big thing. You need to provide three meals a day for every single user that you have,” Scholz said, adding that they stick to the menu provided by a dietician.
“If you don’t have money from government, then how do you provide those types of food to the patients?”
Scholtz said the late payments resulted in staff members having to buy necessities from their own pockets. She said the main issue between NGOs and the department was how they were paid. They are often paid six to eight weeks after they submitted their claims.
Many are unhappy with this because while waiting for the payments, they go into debt to provide services. “That means eight weeks of spending money that we don’t have. Where must we get it from? There is rent, rates, taxes and operational costs. We have staff that need to be paid,” Scholz said.
“We look after people who have disabilities, who require certain medicines. Government gives us a set subsidy. We have to feed them, look after them, house them. You need to pay your rent, your telephone [bill]. Actually, the subsidy doesn’t cover everything.
“We are always fund-raising to get a little extra income so that we continue to operate. But when it gets to us not being paid on a monthly basis, it becomes very difficult.”
According to Scholtz, their monthly operational costs are more than what the government subsidy. However, it did help towards looking after the patients.
Other managers Spotlight spoke to, but did not want to be directly quoted, expressed similar concerns to those raised by Scholtz.
Bloom said most of NGOs got about R4 000 per patient a month, whereas the patients at the privately run Life Healthcare got more than R16 000 per patient. “They need to look at a fair subsidy for all mental health patients,” he said.
According to Bharti Patel, the national executive director of the SA Federation for Mental Health, late payment of subsidies to NGOs was an old problem. She said people have given up on government and felt demoralised.
After the 2015 Life Esidimeni tragedy unfolded, the SA Human Rights Commission (SAHRC) as well as the Health Ombud found that health officials had illegally issued licenses to NGOs that were not equipped to care for patients.
“The current established NGOs, which have been providing residential care to persons with mental health conditions for decades, have used up all their reserves and donations to provide care for which government is responsible. Government is failing its most marginalised citizens once again,” Patel said.
Legislation and policies in place in South Africa state that it is government’s responsibility to provide basic care and services to its most marginalised citizens. Patel said this meant government officials were duty-bound and responsible for making resources available.
“Government does not have the infrastructure and human resources to provide residential services to mental healthcare users in the community. NGOs have been licensed by the departments of health and social development to provide such services. Service level agreements are signed and government is duty bound to honour these agreements,” she says.
According to Patel, the NGO funding policy developed by the national department of social development, took more than five years to be finalised. Each provincial department may develop its own NGO funding policy which did not seem to take into consideration the needs of the communities they serve, she says.
“It is unclear what system exists for the funding of the care of mental healthcare users in provinces. The Western Cape is the only province that ensures proper and adequate funding to NGOs which are therefore able to provide dignified care to mental healthcare users,” she said.
GAUTENG HEALTH DEPARTMENT RESPONDS
The Gauteng health department said under normal circumstances, NGOs were paid their subsidies on time. However, with the start of a new financial year, there were delays due to budget approvals and other supply chain issues.
“The challenge this year was compounded by the renewal of the expired contracts at the end of March, hence an extension of three months was considered while the department was finalising the service level agreements and funding agreements,” spokesperson Kwara Kekana tells Spotlight.
Kekana said there were other changes implemented with the licensing of the NGOs, to align the processes with the recommendations in the Health Ombud’s report on the Life Esidimeni tragedy.
According to Kekana, the department discharged mental healthcare users from specialised mental health hospitals and general hospitals with psychiatric wards.
“This is done when the doctors have ascertained that they have been stabilised and have no side-effects of medication that require close observation by professionals; have had rehabilitation initiated for continuation at district health services level [and when] their residual symptoms no longer require professional care for a longer period.
Currently, there are 145 NGOs in Gauteng licensed to provide services for mental healthcare users with a severe psychiatric challenges or severe and/or profound intellectual disability, she said. These NGOs are monitored on a quarterly basis and assessed based on compliance with legislative processes, the quality of services rendered, and how the organisations are managing their finances.
Asked how they ensured the Life Esidimeni mistakes were not repeated, she said the provincial health department was implementing the recommendations of the Health Ombud’s report. The department was currently “scaling up the implementation and supervision of the recommended national norms and standards for mental healthcare services for residential and day care facilities as stated in the National Mental Health Policy Framework and Strategic Plan 2013-2020”.
But according to Patel, the process of deinstitutionalisation had not worked.
“The recommendations made by the Health Ombud and the SAHRC have not been implemented as government drags its heels. Ongoing delays and failures by health officials to ensure that the system of funding works and ensuring that resources follow the mental healthcare user are yet to be implemented,” she said.
Provincial health spokesperson Philani Mhlungu could not immediately provide an update on the department’s progress in implementing the recommendations.
* This article was produced by Spotlight – health journalism in the public interest.