Gauteng health department is steeped in debt

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Gauteng Health MEC Gwen Ramokgopa. PHOTO: Rosetta Msimango
Gauteng Health MEC Gwen Ramokgopa. PHOTO: Rosetta Msimango

One thing that keeps Gauteng Health MEC Gwen Ramokgopa awake at night is finding the money for her department, which is immersed in debt.

The sheriff of the court has become a regular visitor and attaches goods in lieu of payment of mostly medical negligence claims which, at last glance, stood at a whopping R22bn. The department also owes R3bn to 1 576 suppliers.

While Ramokgopa is not new to the position of health MEC – she held the post between 1999 and 2006 – this time around, she has had to deal with one crisis after another.

It’s been almost a year since she was redeployed to rescue and stabilise the struggling department following an investigation by health ombudsman Professor Malegapuru Makgoba, which found that 143 mentally ill patients died after being moved to unprepared community nongovernmental organisations from Life Esidimeni facilities.

The saga forced Ramokgopa’s predecessor, Qedani Mahlangu, to resign. Former department head Dr Barney Selebano and former provincial director of mental health Dr Makgabo Manamela were also axed.

Ramakgopa assumed office in February, and said her immediate priority was to make sure that the surviving patients of the Life Esidimeni tragedy were assessed, looked after and assisted even before they were moved to new facilities.

“Obviously, it wasn’t easy in the beginning – the staff’s morale was low. We needed to deal with the issue of the reputation damage and trust lost between the public and the department, as well as the rest of the department that was not involved with the Esidimeni tragedy, but was affected by it,” Ramakgopa said.

“We had to deal with the roof falling in at Charlotte Maxeke [Johannesburg Academic Hospital], the forensic pathology strike, the sheriff of the court, accruals and disgruntled service providers.”

Ramokgopa said she believed the department’s woes and shortcomings stemmed from four key areas – a heavy burden of disease; increasingly high population growth numbers; management and leadership within the department; and rocketing medical litigation cases.

She said the number of people suffering from diseases in the province was too high, and “if we go in this manner and not focus on reducing the burden of disease, we’re not doing justice to the economy”.

“The high burden of disease also does not correlate with the resources available to deal with it,” she said.

The population growth in the province also “surpassed” the allocated health resources, Ramokgopa said.

The development of resources has not caught up with increasing number of patients who migrate into the province. For example, in 1999, when she was running the department for the first time, the population stood at 7.9 million. Now it has almost doubled to 15 million people.

In that period, the number of clinics, hospitals and even medical staff has not doubled. The resources, in real terms, have shrunk, Ramokgopa explained.

“With social development, the grant follows the person wherever they are. You go to the SA Social Security Agency points and you get your money because it’s a nationally integrated system.

“But with health, it goes through an equitable share distribution and that hasn’t followed the citizens migrating here, so the baseline needs to increase,” she explained.

“I’m told it’s a cash flow problem. In June, National Treasury warned that the department’s funds would be depleted by September.

“It’s really a problem of mediocrity – instead of giving the department its fair share of cash, it’s then rationed and, in real terms, hospitals and clinics are given less than their fair share and that’s why there are accruals.

“Even national government knows the funds available for the servicing of the 27 million patient visits seen in 2016/17 were grossly inadequate,” she said.

The national department’s 2016/17 annual report revealed that it underspent its budget by R217m. However, Ramokgopa argues that, while the figures reflecting the underspending were accurate, they weren’t a true reflection on what was happening on the ground because of the rationing the department had to do.

In terms of medical litigation, Ramokgopa said the pressing issue was that there was no national legislative framework within which the claims were processed.

“For medical litigation, there has to be framework because there are many gaps making it hard for professionals to prove that they did the best they could under the circumstances – especially for premature babies. If you can’t provide proof, the court finds you guilty of probability,” she said.

Ramokgopa said she had “many sleepless nights” over the limited resources available to the department.

“We have a commitment to pay suppliers within 30 days. We have improved. When I came in, it was at 25% [of invoices settled], but by the middle of the year, we pushed to 45%.

“However, we have more than R2.5bn in invoices sent through and ready for payment, but there is no money,” she said.

When asked why she took the job despite the department’s woes, Ramokgopa said: “I accepted this job to help my people. There are times when what you want comes second to human solidarity.”

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