Durban loses its last public sector oncologist today as shortages of specialists in the province continue.
The doctor’s departure from Inkosi Albert Luthuli Central Hospital leaves KwaZulu-Natal with just two oncologists, both practising at Grey’s Hospital in Pietermaritzburg.
Chairperson of South Africa Medical Association’s KwaZulu-Natal branch Mvuyisi Mzukwa says these two doctors are swamped and dealing with a backlog of patients, some of whom have been waiting for treatment since 2011.
The closure of cancer services may be the latest symptom of what the South African Medical Association (Sama) and human rights organisation Section27 says are the province’s failing health systems. In May, the duo took to the streets to protest issues such as staff shortages, poor working conditions and deteriorating infrastructure and equipment.
In a five-page memo delivered to KwaZulu-Natal health MEC Sibongiseni Dhlomo, Sama alleged that the provinces had severe shortages of specialists such oncologists but also obstetricians, psychiatrists and orthopaedic and general surgeons. The association also said health facilities operated amid shortfalls of soap, gloves, needles and clean linens. Doctors also complained of rat and insect infestations.
As the province’s shortage of specialists grows, so too will waiting lists for treatments, warns Mzukwa.
But KwaZulu-Natal health department spokesperson Sam Mkhwanazi says the department is already recruiting new oncologists and in the interim, private sector oncologists and radiotherapists will provide cancer treatment at Inkosi Albert Luthuli Central Hospital. These specialists will be overseen by the head of Pietermaritzburg’s oncology unit at Grey’s Hospital.
Meanwhile, the KwaZulu-Natal department of health is running a deficit of more than R1-billion this year, according to information presented at the health budget vote in March. This includes an R500-million shortage for HIV treatment for the 2017/ 18 financial year.
The health systems and policy manager at the Rural Health Advocacy Project, Russell Rensburg says some companies contracted to maintain medical equipment and provide medications have not been paid. He explains that many continue to provide services and credits them with helping keep the health system afloat.
Rensburg told Bhekisisa in January that although provincial health budgets have almost doubled in the past 15 years, they have not kept up with the rising cost of employees.
Employee compensation now accounts for about 65 % of provincial health expenditure, according to a 2016 working paper released by the Rural Health Advocacy Project.
Rensburg warns that the country’s recession and ratings downgrade could topple KwaZulu-Natal’s health system if government fails to adjust current and projected budgets that have largely been based on false assumptions.
He explains: “The current budget is based on a projection that the economy would grow by between 1.2 and 1.5% in the next year. But the country is now in a recession and the ratings downgrade will affect our ability to loan money. The department has its head in the sand.”
The recession is likely to reduce levels of taxable income as companies shy away from investing and creating jobs in the country. Meanwhile, the recent downgrade in South Africa’s credit ratings means there will likely be less money for public expenditure as more cash goes to service debt.
Other provincial health departments will also suffer, he says. In September, South Africa introduced new HIV treatment guidelines that now offer antiretrovirals to anyone who has tested HIV-positive, meaning many more people now qualify to receive the drugs than before. Previously, people would have had to wait until their CD4 counts — a measure of the immune system’s strength — fell to 500.
Rensburg says that government is spending money to increase access to HIV treatment and roll out the National Health Insurance while there may not funds to sustain existing programmes.
He explains: “We are facing a financial crisis in health and it is being ignored.”
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Bhekisisa means "to scrutinise" in Zulu
In South Africa, Zulu patients who would like to be thoroughly assessed by a doctor, would ask the physician to "bhekisisa" them.