The South African government, in particular the provincial Free State government, are failing to assume their responsibility to protect access to healthcare services, especially for the poor. This is the main finding of the People’s Commission of Inquiry into the Free State healthcare system, which released its report on Tuesday.
The hearings, which were held in July, were organised by the health activist group, Treatment Action Campaign. The inquiry was set up as a public forum with three commissioners – professional nurse Thembeka Gwangwa, Bishop Paul Verryn and health activist Thokozile Madonko – receiving testimonies from more than 60 people from 15 communities in the province. Civil society, activists and healthcare professionals also made submissions.
The Free State health department has been invited to the release of the inquiry’s report in Bloemfontein, but didn’t accept the invitation. According to Free State health department spokesperson Mondli Mvambi, the launch clashes with a health portfolio committee meeting Health MEC Benny Malakoane has to attend in the legislature.
The inquiry has found that “shortages and stock-outs of medication and medical supplies are chronic, endanger the lives and health of vulnerable people across the Free State and discourage people from accessing healthcare and trusting in the health system”.
According to Mvambi, the TAC and the social justice organisation SECTION27, which is also involved with the hearings, have, however, “concocted the outcome of their findings with regards to drug stock-outs”. “In all the places where they say they’ve found drug stock-outs, the Free State health department and several other bodies have established that there were, in fact, no drug stock-outs. We’ve been sufficiently transparent about the challenges we face.”
According to Statistics South Africa’s 2014 General Household Survey the Free State is home to just under 3-million people with 82% of them relying on public healthcare. The survey found that the province had the third highest ranking in the country of people who reported that they were “very dissatisfied” with the quality of public facilities.
The Free State is the province with the lowest life expectancy at birth in the country and it has the third highest HIV infection rate at 14%, South Africa’s 2011 census reported. The South African Health Review, which was released in October, states that the number of public sector doctors in the Free State had fallen by 24% from 2014 to 2015, which according to the inquiry’s report, is “shocking”, but “unsurprising given the testimony we received from doctors”.
In March the Mail & Guardian’s health journalism centre, Bhekisisa, published the story of Frik Balanco, who died in January at Dihlabeng Regional Hospital in the eastern Free State, after the hospital ran out of special antibiotics needed to treat an infection that was resistant to ordinary antibiotics. Balanco had to wait for days to be seen by a doctor – at the time, the hospital employed only four of the 18 medical officers needed to run a 24-hour service. Because the hospital’s lifts didn’t work, his wife had to hire private undertakers to carry his body out of the hospital.
The commissioners have found that whistleblowing and “even candid engagement” with the provincial health department on the part of healthcare personnel and the public is discouraged and “at times met with severe intimidation”. Doctors at Dihlabeng, who spoke to Bhekisisa on the condition of anonymity, were terrified of losing their jobs.
The commissioners further note: “There is ineffective, unresponsive and unaccountable leaderships, particularly from senior officials [including Malakoane].” The report recommends that the national health department establishes a task team to investigate the commissioners’ findings in the context of a report of the Human Rights Commission, which was published in 2007.
“The South African Human Rights Commission should, as a matter of urgency, return to the Free State and investigate how the situation has changed”, the commissioners advise. They also recommend that the Free State follows the “example set by the national department of health and the Limpopo, Gauteng, Northern Cape, North West and Western Cape” provincial health departments and “engage with civil society on causes of stock outs and potential solutions to improve the supply chain”.
Mvambi said, while South Africa is a democratic country and citizens have the right to raise their concerns about the public healthcare system, his department believes the People’s Commission of Inquiry has not used the “formal engagement channels available” for this. “Instead, they have called the MEC to platforms which are simply disrespectful and insulting to the MEC’s personality. These people and organisations can write to the department and outline their concerns and also engage with us through the legislature instead of establishing their own additional engagement process of which the findings are not binding.”
Mia Malan is Bhekisisa's editor-in-chief and executive director. Under her leadership, Bhekisisa’s online readership increased 30 fold and its donor funding eightfold between 2013 and 2019. Malan has won more than 20 African journalism awards for her work and is a former fellow of the Reuters Institute for the Study of Journalism at Oxford University.