Health – More Transformation, less investigation

More transformation, less investigationIn October, a picture of new-born babies lying in cardboard boxes at Chris Hani Baragwanath Hospital shocked the nation. But Fikile Majola, general secretary of the National Education Health and Allied Workers Union (Nehawu), argues that this picture is common across the public health service and will remain so until government massively increases spending on public health.

The press reveals that babies in Chris Hani Baragwanath Hospital's (CHB) maternity section are sleeping in cardboard boxes because no cots are available.

The National Department of Health is shocked, and sends in a team to investigate. The Gauteng Department of Health (GDH) is shocked, and sends in another team to investigate.

Soon noises are heard from one of the investigating teams: management of the hospital has "failed to prioritise core functions in the allocation of its budget"; R 9.4 million has been spent on phone accounts, compared to the R7 million allocated to medical equipment.

A "team of experts" will be sent in to implement a "turnaround strategy".The Health Department teams do not explain that the hospital budget is drawn up by Head Office, and that management departs from it at its peril.

They do not explain that telephone accounts and medical equipment belong to different line items, and that management does not have the authority to swap them around.

Nor do they explain how you would run a modern hospital without telephones. Nor that the figure they quote for phone accounts is about two years old, and that since then management has successfully implemented a strategy to reduce phone expenditure.

They do not explain that the hospital budget which they draw up bears little relation to real activities in the hospital, nor that management lacks the resources to actually manage a budget.

CHB – Under resourced and under budgeted

The reason babies are sleeping in cardboard boxes is because the institution is grossly under resourced and under budgeted.

Hospital management requested a budget of R 1.6 billion for this financial year.

It was allocated R 1.1 billion, a 7% real decrease from the previous year.It is more than five years since a real injection of funding was provided for equipment at Chris Hani Baragwanath.

The generally accepted norm for an equipment budget for a hospital of this size would be about R 45 million per year, excluding big-ticket items such as CT scans.
Last year the hospital received R 7 million, after being promised R 13 million. This year clinicians were told they would receive a ludicrous R 7 million again, since reduced to about R 2.5 million.

Clinicians don't know whether to laugh or cry.There has been a progressive degeneration of all kinds of equipment because of the lack of a maintenance budget.

The lack of cots is probably the least of the problems. Desperate shortages of ventilators, infusion pumps, scopes, ward equipment, theatre equipment such as operating cameras, theatre tables, electrocauteries, anaesthetic equipment and much more make it difficult and in some cases impossible to provide proper health care to patients.

Moreover, shortage of equipment causes ongoing wastages such as cancelled operations.Under budgeting also means the institution is chronically understaffed.

Out of the 7500 posts allocated to the hospital, only 4800 are currently funded. There has been no reduction of patients or closure of beds to compensate for this.

Government officials are fond of excusing themselves from responsibility by quoting a general shortage of nurses nationally and internationally.

They generally neglect to explain their role in creating this crisis through closing nursing colleges and drastically reducing the funding of nurse training in the 1990s.

Furthermore, government policies increase rather than reduce the pressure on overburdened nurses. In an effort to cut payroll costs in the mid- to late 1990s, government reduced the number of non-nursing support staff, such as porters, cleaners and clerks. These have not been replaced.

The result is that scarce skilled nurses have to do many non-nursing tasks, such as sweeping floors, making tea for patients, taking messages, collecting medicines and pushing patients on trolleys.

The same applies to other skilled categories of staff – doctors, pharmacists, physiotherapists. Government wastes precious tax money and scarce skills making these levels of staff do menial labour like this.Impossible workloads put huge pressures on the existing staff.

This is not only a problem at Chris Hani Baragwanath, but at most public hospitals across the country, as recent events at Frere Hospital in the Eastern Cape demonstrate.

In a recent study of four Gauteng hospitals, Prof Helen Schneider of Wits University found that between 73 and 92% of staff (CHB 92%) felt that there was a shortage of nursing staff, between 71 and 76% (CHB 71%) felt there was a shortage of doctors, and between 61 and 92% (CHB 92%) felt their workload was too high.

Between 35 and 60% (CHB 60%) of staff suffered from high levels of emotional burnout as a consequence.

Doctors and nurses are clear about the impact on the health of patients. According to a professor with many years experience: "Everything is done in a rush, and staff is left exhausted.

Low morale frequently follows, with resulting reduction in the quality of care and avoidable morbidity and mortality."

According to a Chief Professional Nurse: "We had a recent case where the shortage caused a patient who needed turning to get bed sores.

This led to complications and then the patient's death. That's an example of the consequences for patients."Gauteng officials also know what the problems are.

In 2005, Dr Rahman, Chief Operating Officer at GDH, told the hospital management that the hospital was seriously understaffed, and requested it is to submit an expanded staff budget.

This was done. To date there is still no response from GDH. Countless investigations and commissions and research projects have been conducted at Chris Hani Baragwanath and other public hospitals.

Health Department officials at provincial and national level know what the problems are. They should also know what the solutions are: provide realistic funding and resources, and delegate sufficient powers to hospital management to run their hospitals effectively.

Instead, we fear another episode of scape-goating. Investigating teams are sent by those who are actually responsible for the mess, and duly report back that it is the local managers who are to blame.

The local managers are covered in disgrace and removed, and new managers are sent in. Instead of accepting public responsibility for their own budgetary policies, government tries to shift the responsibility to managers and to "a poor work ethic" on the part of public service workers such as nurses.

A few years later it is clear that nothing has changed, and the cycle starts again.The health care conditions at Chris Baragwanath hospital are similar to all other public health facilities in the country, characterised by over-centralised control of hospitals, under-budgeting and under-funding.

This must stop. We call on government to address the real issues: insufficient budgets and disempowerment of hospital managers.

Nehawu has long called for decisive state intervention in the health care system through increased budgeting and universal national health insurance system which will cover everyone, irrespective of whether they have a job or not.

Pull-out quotes:Out of the 7500 posts allocated to Chris Hani Baragwanath Hospital, only 4800 are currently funded. There has been no reduction of patients or closure of beds to compensate for this.

(Government) neglects to explain their role in creating (the nursing) crisis through closing nursing colleges and drastically reducing the funding of nurse training in the 1990s.


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