Keeping track of the Eastern Cape
A special edition of the NSP Review published in September 2013 bore witness to the collapse of the Eastern Cape public health system. Death and dying in the Eastern Cape: An investigation into the collapse of a health system showed that the failure in the province was entirely predictable. For over a decade, department officials and politicians have ignored, and in some cases perpetuated, conditions that cause the death and dying. Their failures continue to violate the rights and endanger the health and lives of six million people.
For those millions, the consequences of the collapse have been catastrophic. The report gave voice to people who work within the provincial healthcare system and those who are affected by it. Their stories revealed the scale and impact of the dysfunction. Ultimately, their stories will become instruments of change for a healthcare system that desperately needs it.
Marching for our rights
Shortly after the report went public, the Eastern Cape Health Crisis Action Coalition (ECHCAC) marched with 2,000 people to the head office of the Eastern Cape Department of Health (ECDoH) in Bhisho. Representatives of the Coalition, including the General Secretary of the Democratic Nursing Organisation of South Africa, Thembeka Gwagwa, the National Chairperson of the Treatment Action Campaign (TAC), Anele Yawa, and former MEC of the ECDoH, Dr Trudy Thomas, addressed the crowd and gave a memorandum to the ECDoH.
The memorandum outlined pressing problems, including the deterioration of health facilities, the unreliable access to medicine and medical supplies and poor administration. It also highlighted the lack of patient transport and emergency medical services, shortages of staff and equipment, poor staff accommodation and the ineffective mobilisation of the provincial health budget.
Responsibility for provincial health systems lies primarily at the door of provincial leadership and the Coalition therefore asked the ECDoH to provide a plan indicating how it would address these issues. The Coalition also engaged the National Department of Health, as it is also obligated to ensure the provision of essential health services.
The Minister steps in
Six days after the march, the national Minister of Health announced specific commitments for interventions in the Eastern Cape (a summary can be found at: www.echealthcrisis.org) These initiatives focused on the OR Tambo District, a National Health Insurance pilot district, and Holy Cross Hospital. The Minister also made a number of commitments related to the rest of the Province.
The Province lags
The provincial health authorities failed to respond to the memorandum within the requested timeframe. Instead, on 17 October, the Department sent the Coalition a five page document titled Eastern Cape Health Systems Intervention. It proposed interventions including changes to the supply chain for medicine and supplies, equipment purchases, infrastructural maintenance, payments of accrued debt owed to staff, the improvement of provincial leadership and management, the development of a five-year budget plan, and the strengthening of institutional capacity and governance.
In response, the Coalition provided in-depth commentary on the document. The document and the Coalition’s analysis are available at www.echealthcrisis.org
The Coalition wrote that it was “heartened that both the national and provincial departments of health have now recognised healthcare services in the Province as a crisis needing urgent attention”.
It also, however, noted that the “ECDoH document is not remotely what the Constitution and the Coalition require in terms of a plan to address the health crisis in the Province.” In sum, the Coalition explained that a proper, lawful plan to turn around the healthcare system would need, amongst other things, timeframes, milestones, measurable indicators and a budget.
Parliament steps in
In late October and early November 2013, the provincial and national parliamentary portfolio committees on health called for hearings on the Eastern Cape health crisis. They summoned the Minister and the MEC as well as the Coalition. Committee members were dismayed at the issues the Coalition had publicised. Some even called for or hinted at the MEC’s resignation. The Coalition committed to working with the department and parliament to fix the healthcare system.
The way forward
The Coalition will continue its campaign for the department to develop and implement a comprehensive plan to fix the healthcare system in the Eastern Cape. It will continue to challenge the national Minister and the ECDoH about shortcomings in the system and their interventions in it as well as make efforts to work with the departments to address the shortcomings.
Constant monitoring will be critical to ensure that current and future commitments to change become realities on the ground. Health professionals and healthcare users should also contribute to the monitoring process. Doing so will enable us to hold the departments accountable for fulfiling the constitutional right to access to health care services in the Eastern Cape.
The Constitution requires a real plan!
In its analysis, the Coalition provided a useful summary of what the Constitution requires of government action. It wrote:
- The Constitution requires that a plan to fix the healthcare system in the Province and fulfil constitutional rights, particularly the right to health, must be reasonable. The reasonableness of the plan may be assessed by criteria that include the following:
- It must be reasonably conceived and implemented.
- It must be capable of facilitating the realisation of the right.
- It must be comprehensive and coherent.
- It must be coordinated in terms of Chapter 3 of the Constitution. This means it must be determined by all spheres of government in consultation and that each sphere must accept responsibility for the implementation of particular parts of the plan.
- Appropriate financial and human resources must be made available for the programme. Budgeting duties apply to national, provincial and municipal governments in appropriate circumstances.
- It must be balanced and flexible and make appropriate provision for short-, medium- and long-term needs.
- It must be transparent, and its contents must be made known effectively to the public.
- It must make rights more accessible to a larger number and wider range of people as time progresses.
- It must make short-term provision for those whose needs are urgent and who are living in intolerable conditions.
- It must be conceived of with an appropriate understanding of constitutional and statutory obligations.
 Government of the Republic of South Africa & Others v Grootboom & Others 2000 (11) BCLR 1169 (CC) para 40-43.
 Id para 41.
 Id para 39 and 40.
 Id para 40 and 60.
 Id para 30.
 City of Johannesburg Metropolitan Municipality v Blue Moonlight Properties 39 (Pty) Ltd and Another 2012 (2) SA 104 (CC) at para 57 and 67.
 Grootboom para 68, 78 and 95.
 Grootboom para 43.
 Minister of Health and Others v Treatment Action Campaign and Others para 123
 Grootboom para 45
 Grootboom paras 44 64, 68, 99; TAC case para 78
 City of Johannesburg Metropolitan Municipality v Blue Moonlight Properties 39 (Pty) Ltd and Others  ZACC 33 at para 74.
 S Liebenburg Socio-Economic Rights: Adjudication under a Transformative Constitution (Juta, Claremont, 2010), p 152.