The struggle in Gauteng
Public health care in Gauteng Province is plagued by drug shortages, poor service delivery and the breakdown of the National Health Laboratory System (NHLS). For the past two years, the Treatment Action Campaign (TAC) in Gauteng has been receiving reports that not only essential drugs like antiretrovirals (ARVs) and insulin but even basics like paracetamol have been unavailable In health facilities.
TAC receives reports of medicine shortages throughout Gauteng. The majority of these reports relate to clinics and hospitals in Ekurhuleni District.
26 May 2011
TAC sends a letter of concern to the Gauteng Provincial Department of Health (PDoH). The letter requests a meeting with MEC for Health Ntombi Mekgwe, in order to discuss service delivery problems in the public health system.
31 May 2011
TAC’s national secretariat issues a press statement condemning the shortage of the drugs efavirenz and lopinavir/ritonavir especially in Gauteng and most notably in Ekurhuleni clinics and hospitals.
The meeting with the PDoH that was requested in May finally takes place on 28 July. The following issues are raised:
• Medicine shortages
• Access to isoniazid preventive therapy for tuberculosis (TB) prevention in clinics and prisons
• Closure of three TB clinics in Gauteng
• Dysfunctional district AIDS councils
Reports indicate that ART shortages are worsening. Some health facilities also run out of basic laboratory requirements like sputum vials and labels for samples. TAC responds by visiting and contacting most clinics in Ekurhuleni and around Johannesburg to establish the extent of the problem. It becomes clear that the NHLS is facing bankruptcy and collapse because Gauteng and other PDoHs have not paid their bills. People suffer as the initiation of new patients on ART is delayed.
In the same month, the Auditor-General’s office releases a report on a performance audit of infrastructure delivery at provincial departments of Education and Health. The report exposes that the Gauteng PDoH has lost millions of rand through maladministration.
TAC Gauteng pickets the offices of the MEC for Health on 12 December to draw attention to the collapse of the provincial health system. Mekgwe refuses to receive the memorandum in person, sending her Chief of Staff Malibongwe Khanjana to accept it on her behalf.
27 January 2012
The MEC responds to TAC’s memorandum of 12 December 2011, stating that she is addressing the non-payment of service providers, including the NHLS. Mekgwe claims that all outstanding debts will be paid by 30 June 2012.
20 April 2012
TAC and SECTION 27 write jointly to MEC Mekgwe, again drawing her attention to the medicine shortages. We copy in Head of Department for Health Nomonde Xundu, Minister of Health Aaron Motsoaledi and Director-General for Health Precious Matsoso.
• The letter raises the problem of patients receiving ARV supplies for only eleven days at a time. The writers point out that this makes it harder for patients to adhere to treatment, especially those who live far from health facilities and those who work.
• TAC and SECTION27 request that the matter be resolved by 24 April 2012.
Their letter remains unanswered.
14 June 2012
1,500 activists and concerned citizens take to the streets to deliver a memorandum to the Gauteng PDoH regarding stockouts of essential drugs. Mekgwe is once again unavailable, so Director of the HIV/AIDS unit Zukiswa Pinini accepts the memorandum and promises to pass it on to the MEC. The DoH does not respond to this communication.
6 July 2012
TAC writes again to Mekgwe regarding the substandard delivery of health care in Gauteng. The letter is copied to the Minister of Health, Minister of Finance and Gauteng MEC for Finance.
17 July 2012
Hope Papo is appointed as the new Gauteng Provincial MEC for Health – the third person to occupy that post in two years. His appointment comes soon after the Gauteng Department of Health and Social Development is split in two to improve service delivery.
27 July 2012
TAC leadership together with the Budget and Expenditure Monitoring Forum (BEMF), SECTION27 and the Centre for Applied Legal Studies (CALS) meet with the new MEC for Health to discuss continuing stockouts of essential medicines and shortages of clinical and support staff at all health facilities. The MEC defers to the Head of Department to respond to these issues.
29 July 2012
TAC holds a press conference to highlight the appalling service delivery problems in the Gauteng PDoH.
The office of the Auditor-General releases its overall findings on the PDoH. It highlights unauthorised expenditure of R1 billion, irregular expenditure of R1 billion, and R155 million in wasteful expenditure.
TAC formally writes to the Special Investigating Unit (SIU) to request access to its report of an important investigation into corruption in the Gauteng Health Department.