Gauteng health struggles: Underspending, patient safety incidences and ambulance crew attacks

Although the Gauteng Department of Health has made progress in some areas, it remains one of the worst-run departments in the province.

The department is one of five out of Gauteng’s 14 departments that received an unqualified audit opinion, with findings indicating non-compliance with supply chain regulations.

“We firstly want to make sure that we improve efficiencies in health. We are going to be working with them to make sure that we get value for money for every service that we provide,” said Finance and Economic Development Member of the Executive Council (MEC) Lebogang Maile during a media briefing last month.

Gauteng health struggles

MEC for Health and Wellness Nomantu Nkomo-Ralehoko, Head of Department Arnold Lesiba, and other senior management presented the annual performance report for the 2023/24 financial year at the provincial public hearing at the Ga-Rankuwa Community Hall on Tuesday.

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In that financial year, the department completed construction on three clinics – Greenspark, Kekana Gardens, and De Wagensdrift. It also opened the Finetown, Sebokeng Zone 17 CHC and Philip Moyo clinics to the public.

Despite these and other projects, the department underspent by R1.18 billion from the R62 billion budget allocation.

“We were able to spend 98.1% of the allocated budget,” said Lesiba.

This was a slight improvement from the R2.71 billion that was not spent in the 2022/23 financial year.

“That money that was not spent, a significant amount of over R600 million was applied for a rollover. That money would have been committed in the pipeline and it would have been rolled over for us to service those commitments we made in the previous financial year,” said Lesiba.

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“Challenges in the areas of township spend — we’re struggling to find some of the things used by the clinics. We are aware of it and we’re putting strategies in place including partnering with the business forums in areas where easy day-to-day commodities that are used should be found in township businesses. The percentage of budget spend on township enterprises procurement decreased by 25.8% from 33.8% in 2022/23 to 8% in 2023/24.”

Gauteng health and medicine availability

The availability of essential medicines also decreased by 1.2 percentage points. This is from 95.2% in 2022/23 to 94% in the 2023/24 financial, according to the health department.

“When pharmaceuticals don’t have an active ingredient supply, they’re not able to supply because we don’t manufacture medication, we buy. When the supplier does not have, all of us don’t have,” said Lesiba.

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“We are performing well as far as distribution on availability. Where suppliers run out, we get out of contracts and find it anywhere we can to ensure medication is available. However, we then buy medication at prime.”

Ambulance and patient cases

The health department further called on communities to work with it in ensuring the safety of ambulance personnel. This is amid incidences of attacks on them as they attend to patients.

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“This has affected how EMS [Emergency Medical Services] personnel respond to emergencies. If we’re going to get to an area where ambulances must be escorted, we’re going to lose a lot of lives because emergency personnel feel unsafe because we know the police do not have enough vans for every ambulance that must go, but we also know that in every emergency, time is an issue,” said Lesiba.

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“We must as a community work in protecting these assets so that when an ambulance is needed, it is found. Last time an ambulance crew was killed for a cell phone, now EMS crew are scared to attend to emergencies.”

The health department is also facing challenges with District Health Services and Tertiary Hospitals, which have failed to close their patient safety incident (PSI) cases.

“When a patient has a severe incident or complication, we must be able to close that issue with the complainant as quickly as possible within 30 days as prescribed.”

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Nkomo-Ralehoko added that the department had managed to reduce the amount of litigation claims from around R30 billion in 2022 to R9 billion in the current year.

“We want to completely eradicate this money that we pay people because of litigations. I’m happy because we don’t have incidents in Tshwane,” said the health MEC.