Budget cuts at the Gauteng Department of Health mean that it will not renew the contracts of more than 800 Covid-19 support staff at Chris Hani Baragwanath Academic Hospital, south of Johannesburg, on 31 March.
A picket was held outside the hospital on Thursday 10 March after it emerged that suppliers hadn’t been paid for services such as bread delivery and biohazardous waste removal.
Chief executive Nkele Lesia said on 11 March that the picket was less about the Covid staff and more about staff shortages. But she offered no plan to address the inadequate number of hospital personnel. Lesia said the Covid staff knew their contracts were not going to be renewed.
“Those 800 posts may have been created for Covid-19, but it provides us an opportunity to redress this imbalance that exists with this hospital having been chronically understaffed,” said Shabir Madhi, a vaccinology professor and the dean of health sciences at the University of the Witwatersrand (Wits). “We can’t just remove the staff – we need to incorporate them into the system so that we can have this hospital better staffed to ensure better quality of patient care.”
He said the issue goes beyond staff shortages. “If we remove them, we will find that the permanent staff come under greater pressure and burn out. They are going to resign, creating a greater disaster. Poor planning on the part of the government is not an excuse to punish patients and healthcare workers.”
Gauteng member of the executive council for health Nomathemba Mokgethi said the department is unable to absorb the temporary staff because of budget constraints. But she extended her appreciation for their help and support during the waves of Covid.
A chronic situation
Madhi said neglect and the inadequate management and training of healthcare workers over the past two years will materialise as a heavier burden from chronic diseases, which have been on the back-burner as the healthcare industry prioritised Covid.
“For the next two to three years, we need to expect high levels of people ending up in hospital dying not because of Covid. With Covid, there has unquestionably been a disruption in the care of patients with other conditions because people haven’t been able to access facilities. People have been delayed in the diagnosis, and for some time they probably delayed with the treatment,” he said.
Mokgethi and her team did not offer a plan to handle diseases that have been neglected either.
Madhi said training has been hampered and Baragwanath – one of the biggest academic teaching hospitals on the Wits circuit – needs to function properly for students to learn comprehensively. “It is going to impact patient care in the years to come, so the disaster we sit upon today is just the beginning of a further rot of the system if we don’t reverse it immediately.”
Mmampapatla Ramokgopa, chairperson of the hospital’s medical advisory committee, said resilient and hard-working staff who have gone the extra mile are what has kept Baragwanath going.
“We have doctors and nurses pushing patients because there are no porters. The same with cleaning. You find nurses and doctors scrubbing the floors because there are not enough cleaners. Sometimes patients delay to get into theatres because the cleaners are not there. They dig into their pockets and make contributions to buy either bread or flour to make bread,” said Ramokgopa.
Patient care at risk
The department denied that Gauteng hospitals have run out of food, saying other types of food are being served at Baragwanath. It did admit that the hospital, along with other facilities, experienced “a short supply of bread in the recent past” and that the issue had been resolved.
Madhi said the hospital and surrounding area were compromised when the department failed to pay the service provider who removes biohazardous waste. The department said on 11 March that it had paid the relevant service providers to collect the waste and supply bread.
“The fact that we are in a province where patients are not provided something as basic as bread for two weeks speaks volumes about the incompetence and uncaringness of those responsible for the management of this facility … at the level of the province,” said Madhi.
Ramokgopa said the committee has raised these matters over time. People who have worked at the hospital for years have a collective memory of its legacy and they are eager to engage and find solutions.
National Union of Public Service and Allied Workers branch secretary Monwabisi Somi said employees are providing much-needed staff for an institution that is under strain, and the Covid workers need to be absorbed. “We’ve also got the issue of telephone lines that have not been working for some time in some units, which compromises communication. This is to the detriment of patient care,” he said.
Lerato Madyo, the provincial department’s acting chief financial officer, said its finances are healthy but it is dealing with a backlog of unprocessed invoices from previous years. The department owed service providers R4.2 billion at the end of January.
Madhi said what is happening in state healthcare facilities is compromising the future care of people in South Africa. “It is undermining our ability to provide adequate training to healthcare workers.”