Gert Sibande in bad shape

Government leaders and the SA National AIDS Council were due to host their World AIDS Day events in Mpumalanga’s Gert Sibande district while activists were planning a protest. However, once the leftover food is cleared, the banners rolled up and the marquees trucked away and the delegations drive off in their slick vehicles, a district in desperate need of serious intervention remains behind. Kerry Cullinan of Health-e News Service turns the spotlight on the district.

According to The 2011 National Antenatal Sentinel HIV & Syphilis Prevalence Survey in South Africa, 46% of pregnant women in the Gert Sibande District of Mpumalanga were HIV-positive – the highest rate in the country. Unsurprisingly, The District Health Barometer (DHB) 2012/13, published by the Health Systems Trust, paints a picture of a district burdened by weak and dysfunctional management. Approximately one million people depend on a district that appears to lack adequate skills, commitment and staff, and is unable to cope with the challenges it faces.

While the reduction of maternal mortality is one of the highest priorities of the national Department of Health, maternal mortality in the Gert Sibanda District (the number of women dying during pregnancy or shortly after giving birth) has more than doubled from 76.4 deaths per 100,000 live births in 2011/12 to 187.6 deaths in 2012/13. (The national average is 132.9 deaths.) Research shows that some 40% of maternal deaths are preventable, particularly if care during pregnancy is good. This rapid rise in the number of maternal deaths within a single year therefore clearly indicates that the services in this district are inadequate and that case management is poor. Achieving the Millennium Development Goal of reducing maternal mortality to 38 deaths per 100,000 births by 2015 will not be possible in this region.

Studies have indicated that rates of cervical cancer are higher in women with HIV. According to national guidelines, all HIV-positive women should be given a pap smear test to check for cervical cancer as soon as they are diagnosed with HIV. However, in the Gert Sibande District, less than half (45.8%) of this target group were screened, a rate nearly 10% lower than the already poor national average of 55.4%.

The Health Facilities Audit of Gert Sibande published by the Department of Health in 2011 reported that the district had performed “very badly” on most indicators, including all subdomains relating to patient safety, the rights of patients, and facilities. In part, these failings were caused by a failure to fill health service posts: a Health Facilities Improvement Team dispatched to the district in 2011 by the Director-General, for example, reported that “the average vacancy rate in hospitals is [only] 61% across all categories”.

Health MEC Candith Mashego-Dlamini acknowledges that the province is struggling to attract health workers. Almost half of the posts for doctors remain vacant (a shortage of 557 people), while almost 60% of specialist posts (90 personnel) and 21.2% of professional nursing posts (1,331 personnel) remain unfilled. The Health Facilities Improvement Team reported that “Mpumalanga [Province] has the second lowest staffing level of doctors to patients (2.31 doctors per 10,000 [patients])” and that it would cost R2.1-billion to bring the province in line with national averages.

Despite these staff shortages, the Gert Sibande District has slashed expenditure on its eight district hospitals by almost half since 2004/5. Although primary healthcare clinics in the district have benefited from a rise in expenditure during this same time period, district bureaucracy now consumes 7.2% of the entire district budget, a rate almost twice the national average of 3.4%.

In September, TAC members held a picket in the district to protest against “the appalling conditions under which healthcare workers are working”, staff shortages and delays in making appointments. Specific grievances were raised about particular health facilities, including the fact that the intensive care unit (ICU) at Ermelo Hospital was not functioning, that patients at the hospital were not getting proper food, that delays had occurred in the construction of the Rob Ferreira Hospital, and that stock-outs of medicines were occurring.

The MEC’s response to these specific complaints noted that:

• Ermelo’s ICU had been closed due to renovations to an adjoining building that had made the unit unsafe. The Ermelo ICU, the MEC noted, should re-open in December “pending the completion of renovations of the two surgical wards”
• Interruptions to food deliveries to Ermelo Hospital had been caused by a shortage of cold storage and additional cold storage had been procured
• The delay in construction at the Rob Ferreria Hospital was due to because a contractor not receiving payment and therefore abandoning the site. Ward upgrades were expected to be finished in November and the new rehabilitation centre was expected to be finished by March 2014.
• Water supplies at the Rene Clinic were not functioning properly because a tank which had been supplied was broken. A new borehole would be drilled during the next financial year.
• There was a shortage of both ambulances and ambulance staff. More emergency care officers would be employed by December and ambulance procurement was underway.

The Treatment Action Campaign has said it will keep a close eye on the district to ensure that these promises are met and that improvements are made. www.health-e.org.za