Free State: No end to the suffering and desperation

Free State: No end to the suffering and desperation

In July, a ‘People’s Commission of Inquiry’ will take place to hear testimony to the severe and sometimes fatal challenges in accessing adequate healthcare in the Free State. Almost every day we receive reports from the province with details of unnecessary suffering and desperation. We hear about frightened patients waiting weeks, months or even many years for urgent medical care. We hear from exasperated health professionals, terrified to speak out publicly for fear of reprisal. We see patients turned away again and again, due to medicine shortages, or broken equipment necessary to save their lives. We witness hospitals and health facilities with no running water, toilets or electricity. We see the impact in impoverished communities of a hospital suspending almost all its services, and sending people as far as 100 kilometres away to another facility.

Conditions at Dihlabeng hospital in Bethlehem are dire.
Conditions at Dihlabeng hospital in Bethlehem are dire.

An independent commission, headed by a panel of independent experts, will be brought together to hear these distressing and sometimes devastating testimonies, and others like them. A report will be published following the inquiry that documents the complaints and provides a clear and thorough set of recommendations for change. Government officials, including both Premier Ace Magashule and MEC of Health Benny Malakoane, have been invited to listen and respond to these truths. The Public Protector and the South African Human Rights Commission (SAHRC) are being engaged. Later this year the SAHRC will be holding a national hearing into the right to health care. The outcomes from this commission will be presented at these hearings in an effort to hold Government (the Minister and MECs) to account. Political parties, government departments, unions and the media have already shown strong interest. We call for written submissions* from interested and affected parties ahead of this incredibly important inquiry to help shape proceedings.

What we know is that the Free State health system has virtually collapsed, and urgently requires a drastic and emergency response from the provincial government. Only serious commitment and political will can turn this situation around. Yet, as patients continue to suffer and even die, the Free State government continues to respond by denying that this crisis exists. Instead of taking the radical and urgent action needed to improve conditions, the provincial government victimises and blames those who speak out against them. The People’s Commission of Inquiry seeks to expose the truth. How did it get this far?

The crisis dates back to the early 2000s, when the government’s change in economic policy failed to recognise the inequity between different provinces. Provinces like the Free State did not receive the investment in infrastructure needed to meet social needs. In 2005 the vital roll-out of antiretroviral medicines (ARVs) only compounded the problem in the province. The lack of existing health infrastructure, low capacity and resources to deliver, and poor planning, contributed to the province continuing to struggle to initiate patients onto ARVs quickly enough to meet the high demand, and treatment remained inaccessible for many.

Eventually, in November 2008, as part of a series of cost-curtailment measures to deal with the province’s poor financial administration, a devastating moratorium on initiating new patients onto ARVs was ordered. Tragically, according to conservative estimates by the HIV Clinicians Society, at least 30 people died each day during the period of ineffective ARV scale-up, as healthcare providers were forced to turn away patients who looked to them as their last hope in life.

Corruption, apathy and continued financial mismanagement have only worsened the situation; and today, the Free State faces the worst rate of life expectancy in the country, at just 50 years. There are more stock outs of essential medicines and supplies than any other province, with hundreds of medicines in short supply. “We often experience shortages of HIV testing kits, gloves, needles, and other equipment,” report community healthcare workers (CHWs). “Many hospitals teeter on the brink of collapse, barely managing on minimal doctors and nursing staff,” report whistle-blowers in an open letter** crying for help.

In April last year, hundreds of CHWs in the province were dismissed without warning or cause. A peaceful night vigil was held in response as a desperate last resort to call for their jobs back, and to protest the dysfunction in the province’s healthcare system. However, instead of receiving a reasonable response from the authorities, the group of mainly elderly women was bundled into the back of police vans and locked up in cold cells for 36 hours. “Why were we fired? I do not know,” states Mokhitli Mokhehle, one of those arrested, who is now struggling to survive without an income.

Protestors outside the Bloemfontein Magistrates Court at an appearance of the Community Health Workers.

The majority of the CHWs are unemployed and have little or no money. Most of them are women with families, and many are elderly. The CHWs spent many years receiving little and irregular pay, and enduring undignified conditions of employment, in order to serve some of South Africa’s poorest and most vulnerable communities. A year after being arrested, they will face trial in July. The trial will cost the taxpayer hundreds of thousands of Rands, aside from the wasted time of police witnesses, the public prosecutor, the magistrate, and court officials in the Free State – money that could have funded the critical work of countless CHWs instead.

The reality for the HIV response is that the ARV programme depends on the CHWs to function. “A friend of mine died last week, because of AIDS. She was on ARVs for a while, but died because there was no one to fetch the medication for her, said CHW Paulina Tsweu, during her last court appearance.

The biggest ARV programme in the world needs the CHWs to deliver treatment to those unable to attend the clinic, to trace defaulters, to provide HIV counselling and support; even, in some cases, going above and beyond, in providing food to those without. They also need to support health workers, who face massive numbers of patients in clinics and hospitals. The national Minister of Health has stressed that he has little power to intervene in the province; yet the programme is at threat – a threat that returns us to the days of the ARV moratorium, when those who couldn’t access treatment died.

For years the Treatment Action Campaign and other partners have attempted to engage both Magashule and Malakoane, who continue to deny the evidence and victimise doctors, nurses and activists who speak out. The state of the province’s healthcare system can never improve under the leadership of Malakoane, who lacks the ability and desire to make the changes. We won’t rest until all people in the Free State are able to access quality, dignified, and humane healthcare services, as required by South Africa’s Constitution. But don’t take my word for it – attend the People’s Commission of Inquiry, and hear it for yourself.

Fatshe ka Benny Malakoane!!! 

Pele to quality healthcare services!!

*For more information about the People’s Commission of Inquiry or to make a written submission, contact, or 081 818 8493. Written submissions must be made by the end of Friday 19 June 2015. 

**An open letter from a group of anonymous doctors working in the Free State public health system was published in GroundUp on 27 February 2015. It can be accessed here: