NSP REVIEW COMMENT

For years, the National Health Laboratory Service has been a gem – a national treasure that operated efficiently and professionally. However, for the past four years a deepening financial crisis at this institution has seen over 1 200 staff members leave, and little or no maintenance or infrastructure development taking place. More recently there has been an upheaval within the Board, with both the Chair Associate, Professor Gonda Perez, and the Deputy-Chair, Dr Fazel Randera, removed – reportedly by the Minister of Health. If this country wishes to respond effectively to our disease burden, we cannot let the NHLS continue to operate under this strain. We simply cannot afford to lose this treasure. In a desperate attempt to draw further attention to the plight of the NHLS, the Treatment Action Campaign, with the support of partners, has composed an open letter to the Minister. 

 

Honourable Minister Dr Aaron Motsoaledi,

<p class=”intro”>We are writing this open letter to you as a group of people who share your deep concern for the quality of healthcare services in South Africa. As concerned parties, we dedicate our lives to ensuring that people receive these lifesaving services. As patients and Treatment Action Campaign members, our lives depend on these services.</p>

As you know, the National Health Laboratory Service (NHLS) forms the bedrock of our public healthcare system. This is a world-class institution that has, over the years, been driven by many talented and committed people. In the many years we struggled for AIDS treatment, we did not have to worry about the testing side of the equation. We did not have to worry about viral load tests, TB tests or CD4 counts being done correctly and in a reasonable time. We worry that this is now changing.

For the last four years, the NHLS has been lurching from one financial crisis to another. We understand that the financial crisis is mainly due to KwaZulu-Natal and Gauteng withholding payment from the NHLS. We also understand that KwaZulu-Natal continues to do so. While we know that there are disputes about billing systems, we believe these to be red herrings. When people’s lives are at risk, you do not allow billing problems to drag on for four years.

Honourable Minister, we appreciate that you are changing the way that the NHLS is funded, and that you are attempting to sort out the financial mess of recent years. We are also aware that you intervened late last year to attempt a turn-around in NHLS management. We do not doubt your good intentions. We sincerely hope that going forward, the NHLS’s finances will no longer threaten the viability of this essential service.

However, having watched the exodus of hundreds of skilled personnel from the NHLS, being aware of labs closing down temporarily, and hearing the serious concerns expressed by our colleagues who work in the NHLS, we remain very worried. Staff morale is at an all-time low, the Board chair and deputy-chair have left, and the executive is unstable, with an acting CEO. In addition, some of us have noticed a decline in the quality of testing services provided by the NHLS – which may or may not be indicative of a larger breakdown within the service. We hope not.

Honourable Minister, we believe that the only productive way forward is to be open with each other and to be guided by our common interest in a well-functioning NHLS. We have noted some of the statements you recently made on the Redi Tlabi show on Radio 702/CapeTalk. To this end, we request that you share with us the following information relating to the debt, and particularly the role of KwaZulu-Natal (KZN) and Gauteng therein:

1. Is it illegal in terms of the Public Finance Management Act for a province to delay payment beyond 30 days on a valid invoice, in the absence of a formal, legally-compliant contesting by the province of that invoice?
2. KZN and Gauteng owe the NHLS more than R4 billion. What Rand-value of that R4 billion invoiced by the NHLS has been formally contested by either KZN or Gauteng in a legally compliant manner, as per 1 above? (As you are aware, the investigation by the Office of the Accountant General is not a legal part of contesting an invoice).
3. Did you issue a formal letter to KZN in 2014 ordering them to pay the NHLS in accordance with the NHLS Act and according to the fee-for-service model?
4. If yes, is this being ignored by KZN?
5. Are the actions of KZN in not paying the NHLS according to the invoices issued to them illegal in terms of the Public Finance Management Act (PFMA) and the provisions of the NHLS Act, which empowers you as Minister to determine the fee level per test and the manner in which the NHLS must invoice provinces?
6. Looking into the next financial year – can you confirm that, despite your letter instructing KZN to pay on a fee for services basis, KZN have not budgeted sufficiently for the 2015/6 financial year in terms of procuring (and paying for) laboratory services from the NHLS?
7. Can you confirm that the current combined debt from non-payment by all provinces of the NHLS is in the region of R5 billion?
8. Can you confirm that the NHLS has had an unqualified audit for the last five years, and are thus considered by the Auditor General to be operating within the law, and according to globally acceptable accounting practices?
9. Is the NHLS obliged in terms of the PFMA to pay its Bills to creditors within 30 days?
10. Can you confirm that at the end of April the NHLS owed approximately R300 million to three suppliers alone, and that around half of this debt has been unpaid for more than 90 days after invoicing?
11. Can you confirm that the three companies who are owed in excess of R300 million are key suppliers enabling the NHLS to carry out TB and HIV Viral Load tests; and that if they refuse to offer a service going forward because of bad debt, that this could endanger the entire ARV and TB programme?
12. As of today, a) what is the number of NHLS suppliers that are owed money by the NHLS for more than 30 days, and b) what is the total amount owing to all creditors by the NHLS that has not been paid within the 30-day time limit determined by the PFMA?
13. Can you confirm that the main reason that the NHLS is not able to pay its debt is because KZN and Gauteng are not paying for services rendered?

Honourable Minister, we stand ready to play our part in ensuring that the NHLS functions as it is supposed to. The public interest and the Constitution of South Africa compel us to work together and to find solutions.

We would like to note that the breadth of the questions above is a reflection of the fact that we have been approached by many current and former employees of the NHLS, as well as academics, researchers, clinicians, suppliers, and health workers, who are extremely concerned – but have not agreed to being named, as they are fearful to speak out as they may be sanctioned or face resistance going forward.

We look forward to hearing from you.

Sincerely

Anele Yawa, General Secretary, Treatment Action Campaign

Dr Mzukisi Grootboom, Chairperson, South African Medical Association

Dr Gilles van Cutsem, Medical Coordinator, Doctors Without Borders (MSF), South Africa

Dr Godisamang Desmond Kegakilwe, Chairperson Rural Doctors Association of Southern Africa (RuDASA)

Professor Francois Venter, Department of Medicine, University of the Witwatersrand

Marije Versteeg, Director, Rural Health Advocacy Project

Dr Prinitha Pillay, Rural Health Advocacy Project

Dr Kevi Naidu, KwaZulu-Natal Provincial RuDASA Representative

Dr Tshilidzi Sadiki, Chairperson, Junior Doctors of South Africa