No money to keep state clinics open 24 hours a day, Parliament hears

Patients wait for hours to be attended to at Sead Clinic, Bethal East, Mpumalanga, during a visit by The Citizen, September 2019. Picture: Nigel Sibanda

DA MP Evelyn Wilson said while most clinics were dysfunctional, the National Health Insurance would not succeed.

Financial pressure on the country’s fiscus, staff shortages and security concerns.

These were just some of the reasons the National Department of Health gave as to why most state clinics and primary healthcare facilities cannot operate 24 hours a day.

Officials presented their input on the National Health Amendment Bill during a briefing of Parliament’s Portfolio Committee on Tuesday.

The bill, submitted as a private member’s bill by EFF MP Dr Sophie Suzan Thembekwayo, proposes that government clinics operate 24/7.

Ramphele Morewane, chief director of district health systems at the National Department of Health, said given the country’s current financial stress, it would struggle to adjust the current budget against the health requirements of the Covid-19 pandemic.

“It is necessary to secure funding for the implementation of legislations. The funding of the bill is very much important; the government budget cycle determine the strategic objectives and the annual performance plan to achieve the goal of the government of the day. The bill in the current form will have a massive financial implication for the department and the ministry,” he said.

Morewane said it is likely that the legislation is not the most appropriate to ensure clinics operate 24 hours a day.

“There are clinics currently that are operating for 24 hours but they were not legislated before they could operate for 24 hours. It may therefore not be necessary to legislate for the clinic to operate for 24 hours. The socio-economic impact assessment system (SEIAS) process would have assisted the proposer to use an alternative method to increase the number of clinics operating for 24 hours. This bill has not been subjected to this SEIAS process,” Morewane said.

He said as and when resources become available, more clinics would be able to run 24-hour operations.

“The data relating to how many health establishments open for 24 hours and how many do not operate 24 hours is critical to determine the exact costs of health human resources personnel, medical equipment, administration personnel and security required. The introduction of 24-hour services requires data relating to human and other resources required for the implementation of 24 hours in the health establishment, and the uncertainty of the funding of the expanded services,” he said.

Some clinics, Morewane said, do not have the capacity to manage after-hour emergencies.

“The facilities are not able to operate for 24 hours because of shortage of human resources, coupled with the lack of additional space for the extended hours of services. Some of the nurses have been threatened or assaulted while working for extended hours. This has led to the staff being scared to work after normal hours,” he added.

EFF MP Naledi Chirwa said: “Clinics and hospitals that you brag about, that you count as being operational for 24 hours do not have the capacity. If the issue is infrastructure, you strengthen infrastructure. If it’s human resource, you build and strengthen human resources, you don’t just sideline it. Of course there will be challenges.”

DA MP Evelyn Wilson said while most clinics were dysfunctional, the National Health Insurance would not succeed.

“What we are seeing here is a pipe dream. From the outset we must not mislead the public, who are expecting new and operational clinics. If we do not have operational clinics, let alone 24-hour clinics, how then do we implement the NHI?” she said.

Currently, 125 clinics are operating 24 hours a day in the Eastern Cape, 35 in Gauteng, 90 in KwaZulu-Natal and 11 in the Western Cape.

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