Will NHI break the cycle of dysfunction in the Eastern Cape?

COMMENT

Last August, Health Ombudsman Malegapuru Makgoba released his report on Tower Hospital, an Eastern Cape psychiatric facility that had been in the limelight for alleged human rights violations. He repeatedly said that the provincial health department’s historical mismanagement and neglect was a “series of successful failures”, and called for the department’s mental healthcare responsibilities to be reverted back to the Minister of Health.

The subtitle of the report is “My name may be Tower Hospital, but my surname and my ‘isiduko’ is the Eastern Cape Health Department”. In other words, no matter what the facility is called, it’s only an extension of the failing department.

“Series of successful failures”

To call the Eastern Cape Department of Health a “series of successful failures” speaks to the department’s history of reactionary and defensive responses to crises that only seem to come after a media exposé or oversight visit. However, instead of a “series” the word cycle might be more fitting, and a vicious one at that.

The cycle goes like this: a crisis emerges, a media exposé/civil society report is published, the department acknowledges what’s been published and promises to act. Words like ‘task team’, ‘commission’ and ‘investigation’ are used as political PR tools to soothe the fears and worries of citizens, but in the aftermath of such words, little changes.

There are comprehensive reports from the South African Human Rights Commission (SAHRC) on mental healthcare and Emergency Medical services, the South African Society of Psychiatrists (SASOP) on Tower Hospital, Section27’s “Death and Dying Report” and various departmental task team reports that pinpoint exact issues within the Eastern Cape.

The reports typically make recommendations with timeframes, but, these reports and their hopes for improvement seem to go nowhere. Instead, they mark the end of the cycle, and similar to what it says on the back of a shampoo bottle; rinse and repeat.

In August, Spotlight published an investigation on the derelict condition of the Cecilia Makiwane Mental Health Unit in Mdantsane, East London. The story got the attention of readers as well as the Public Service Commission (PSC), who made a surprise visit to the facility 10 days later. The PSC was just as horrified with the state of the unit as Spotlight was, and promised to table a report, inclusive of recommendations, within two weeks to the legislature.

However, despite requests for comment to both the PSC and the Eastern Cape Department of Health, it’s still unknown as to whether this report has seen the light of day. The PSC’s visit to the facility was on 16 August, and now nearly two months later, the situation at CMH is far from improved. Instead, the department has continued making promises of better security, better lighting and better fencing; the same promises that were made before Spotlight’s investigation.

Tellingly, Makgoba’s report on Tower Hospital called the department’s response to some issues “damage control”, and questioned why they had been left unattended until a public crisis emerged. A notable example of this is the department’s sudden decision to demolish and re-build the seclusion rooms at the hospital. This action came months after a report by SASOP and ongoing media coverage; Makgoba questioned this sudden decision as a potential “cover-up”.

“Window dressing”

A recommendation in Makgoba’s report included the appointment of a Mental Health Administrator to correct systemic failures in the province. But, the appointment of this administrator, Professor Dan Mkhize, seems to have brought little change except for performative ‘window dressing’. Requests to interview Mkhize at the beginning of the year were quickly rejected. All the public can tell (according to the Eastern Cape Department of Health’s Facebook page) is that Mkhize is working on a report for Makgoba, documenting his findings and analyses of the provincial mental healthcare system. Mkhize has accompanied the MEC on various facility visits and departmental summits, but his voice is yet to be heard, and his actions yet to be felt, in the public space.

Recently, the department announced R236 million to improve psychiatric facilities over the next 3 years (about half of what they themselves assess is needed), but whether fixing windows, walls and building new facilities will address systemic issues, is another question. For a department that has suffered from critical staff shortages in the mental healthcare sector for years, the choice to prioritise brick and mortar over human resources is debatable.

On 31 October, the department opened a brand new 72-hour psychiatric observation unit at Livingston Tertiary Hospital in Port Elizabeth, but as of last year, the area had only 3 psychiatrists in the public sector. Provincially, there are less than 20.

“It is still a sad reality that approximately 40% of psychiatrists are servicing the public sector with a demand burden of over 44 million South Africans.”, said Health MEC Sindiswa Gomba at the opening of the facility.

“The National Health Insurance is a vehicle to provide Universal Health Care wherein such disproportions of services would not be existing. It is only through implementation of NHI that the country [can] come close to correcting this anomaly.”

So, would the Eastern Cape Department of Health, supposedly rebooted under the banner of NHI, remain prone to the same cycle of dysfunction?

Waiting on NHI

Just like the department will wait for a report or an investigation, it now waits for the NHI with high hopes of a magic cure-all to fix years and years of issues. They can build new facilities, purchase new ambulances and beds, and maintain their Facebook page with well-written posts and pictures. But unfortunately maintaining image is not the same as maintaining a healthcare system.

When you have a department that has over R24 billion in medico-legal claims, and can’t afford to fix the CMH Mental Health Unit, colourful talk of the NHI fails to drown out these harsh realities.

While the department continues to prepare for the NHI, in whatever way they see fit, it cannot be ignored that healthcare workers, patients and their families are being pushed farther and farther into a corner. The more the department prioritises image, damage control and their own personal interests over people’s lives, the more precarious the system becomes. Whether the NHI happens or not, no healthcare system can flourish with a poor foundation.