A new coalition for people-centred health care

Brainstorming at the Provincial Health Assembly on mental health and migration.

By Ufrieda Ho

Two specific issues emerged as priorities for Gauteng from the Provincial Health Assembly this year: migration and mental health.

Migration has always been part of human behaviour, moving to and from places for better opportunities or to flee harsh, untenable living conditions. The challenge of managing health care in the context of migration, though, can be complicated. Undocumented individuals who have no medical records, or are suspicious of anything associated with the state, remain highly vulnerable and they are prone to fall through the cracks. There can also be language and cultural barriers and a state of perpetual transience that makes sticking to health-care regimes or follow-up medical checks difficult for patients.

Gauteng is also subjected to xenophobia directed at those who are seen as outsiders taking up scarce resources in the economic heart of South Africa, which makes managing migration a heightened priority for the province.

But it’s mental health issues that have come into sharp focus for the province, brought into the open with news breaking in September that 36 psychiatric patients, who were among 1,300 patients relocated from Life Esidimeni facilities to NGOs, had died. Life Esidimeni, a subsidiary of the Life Healthcare Group, cared for indigent patients, and were part of a public/private partnership that worked under contract to national and provincial health departments.

The patients who were reported dead, died within three months of the MEC for Health’s decision to end her department’s contract with Life Esidimeni. She said that the facilities were too expensive.

SECTION27 has represented The South African Depression and Anxiety Group (SADAG), the South African Society of Psychiatrists, SA Federation for Mental Health, and a number of families since last year, when the decision was taken to relocate the patients. SECTION27 believes the number of reported deaths is an underestimate.

‛Besides not having accurate records of where users are or which users have died, it does not include deaths at home or in other hospitals (SECTION27 is aware of at least one death in each of these categories,’ it was stated in an open letter to the MEC, dated 22 September. The letter is signed by SECTION27, the TAC, SADAG‚ the People’s Health Movement-South Africa‚ the Public Health Association of South Africa and the Junior Public Health Association of South Africa.

The crisis around mental health has spurred the revitalisation of a new coalition seeking to

revitalise the Gauteng People’s Health Movement (PHM). The PHM is a global network that draws together grassroots health activists, civil society organisations and those representing academic institutions. The PHM promotes health care that is guided by the People’s Charter for Health and is meant to present an alternative to health-care models that are not meeting the needs of society’s most vulnerable members.

The approach is to look for horizontal links and collaboration in health-care practices, rather than remaining stuck in a top-down, silo-approach to implementing programmes and plans.

It was this new coalition that called for a meeting with the Gauteng Health MEC, Qedani Mahlangu, in October 2016, demanding clearer answers for the families of the 36 mentally ill patients who had died. It also sought to open up channels for dialogue, communication with the Department of Health, and to hold the authorities to account.

‛What we are saying is, we want to work together with the Department but we also believe that the truth has been lost somewhere, and we are still looking for answers for the families of the patients.

‛Going forward, we want to be equal partners with the Department of Health in deciding how the treatment of high-level-needs patients can be met,’ says Shehnaz Munsi, an occupational therapist, part of the PHM and a master’s student at Wits University.

At the meeting, the MEC stated that the high costs of care, which she said had a similar price tag to intensive-care treatment at a private hospital, was what swayed the decision to relocate the patients.

Mahlangu also claimed that family members of some the patients had been ‛coached and coerced’ into slamming the Department of Health in the media. She added that other patients had been happy with the department, and had phoned her privately to express their thanks.

Mahlangu, who has come under intense scrutiny since the news broke and who been fighting off calls for her sacking, acknowledged the new coalition and committed to more regular meetings. She invited members of the coalition to accompany her and her team for unannounced inspections of the mental health facilities in the province.

The coalition has called for the current investigation into the deaths to be given terms of reference wide enough to establish the immediate and root causes of the decision to discharge patients. They have also called for an audit of the NGOs that are taking care of patients and a list of the other former Life Esidimeni patients who are being housed, with an update on their treatment plans and current health status.

The coalition is still in its infancy but Professor Laurel Baldwin-Ragavan of Wits University’s Family Medicine department, who is also part of the coalition, says the umbrella body is ‛about galvanising many people across sectors of society to apply their minds to solve complex health and social issues.’

By strengthening networks within networks, we can present a powerful force to shift the inequalities that exist in health care today, and to work on alternatives for improved models of health care that are responsive and relevant for the urgent health needs of a modern world.