A recent video of conditions at the Helen Joseph Hospital in Johannesburg highlighted the problem of deteriorating public hospitals yet again. How do we fix our public hospitals? An expert says money is not the problem.

The secret is to keep politics out of the national and provincial health departments.

Professor Alex van den Heever, chairperson of the Social Security Systems Administration and Management Studies at the University of the Witwatersrand, says government will have to basically change the leadership structures of the health department to fix the public health system.

“One of the main challenges will be to create a separation of powers between the member of the executive (the minister or MEC) and the head of the department, as well as a separation from the people who appoint the hospital CEOs.”

He points out that former health ombudsman, professor Malegapuru Makgoba, said the Gauteng Department of Health is a Mickey Mouse operation. “That is a broad, comical description of basically a bunch of people who should not be in positions of leadership running an extremely complex department.”

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True professionals must be in control of public hospitals

What is really required, Van den Heever says, is that true professionals are in charge of these hospitals as the top management of each hospital runs a multi-million rand organisation. “But we have people who are untrained for those positions, who are political appointments and they turn a blind eye to corruption which is potentially why they are there.

“When something goes wrong, they are protected. They are not removed. Look at what Tom Holland is saying now. Remember what happened at Rahima Moosa hospital when one of the paediatricians exposed what is going on in that facility and blew the whistle: he was immediately suspended.”

Van den Heever says this is what happens in such a toxic structure which is really designed for extraction, which means the people who do their job are the last people they want to have in those positions. “With corruption, they want people there who will make sure the money goes where it should.

“They do not appoint donkeys into senior positions who oversee the staff while the trade unions get shut out. There is not an attack on unionisation which is a good thing, but the unions there are part of this extraction network. Nehawu is not an innocent union. They are people who benefit from proximity and their privileged relationships with the ANC.

“Basically, they call the shots. You have the tail wagging the dog in the way your own organisation manages the public sector. The person running a hospital must run it, not be told what to do by the staff.”

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Independent boards not appointed by ANC must appoint public hospital CEOs

He says we need independent boards for hospitals that are not appointed by the ANC. “Then if the boards appoint CEOs and CFOs you will see a fundamental change in performance because there will now be a credible department that maintains the facilities management.

“Many of the things that Holland pointed out in his video are not under the direct control of the hospitals. Infrastructure development, for instance, is meant to do maintenance and this is a department that cannot even maintain its own building, let alone anybody else’s.”

Van den Heever says this system lets CEOs basically sit back and say it is not their problem. They can say they cannot fix anything, cannot sink a borehole and get the water going do any maintenance get generators in or implement solar.

“Public hospitals in France or Germany or Australia are run by the people in charge of them. There is a single clear captain of the ship and you know who to hold accountable if anything goes wrong. If you put any old Charlie into that position, they turn a blind eye to what happens in procurement and they turn a blind eye to everything that happens in infrastructure. “When they are held to account, they say they are in control of nothing.”

He says hospital CEOs should be in control of meals, of all of the equipment arriving and maintaining the actual registers. “But somehow they are not while there is enough money in our public health system to turn it around. However, they cannot turn it around with this structural interference in the medical function of the public health system.”

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Cutting posts due to counterproductive decisions of national government

Van den Heever says the current cutting of posts in education is also related to the counterproductive decisions made at the national level of government.

“They want affordable salary increases but it is unaffordable. They cannot finance these increases and this is again due to the proximity of the unions to the ANC that makes a political decision about increases and then they somehow expect money to magically come out of the ether as they do with the NHI.”

He says the problem is that there is not enough money and power gets squeezed. “We have unemployed doctors. We cannot basically afford the current system. It is also the job of the national ministry of health to control but it is unable to manage the situation and they now have a disastrous situation emerging at the provincial level in basic education and healthcare.”

There is not enough money for these posts and Van den Heever says the test is when you see the Western Cape under stress, you know it goes all the way to the national department. “The Western Cape makes sure they do not run over budget by basically getting on top of the issue of posts by cutting posts very early on so that there is less damage down the line.”

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Government too relaxed about public hospital crisis

Van den Heever points out that another problem is that government is so relaxed in how they approach this, allowing a massive crisis to exist. “They stop paying and at the last minute, they start cutting posts. They all go into crisis mode and freeze all posts.

“Now when we need an anaesthetist, you cannot appoint one. It is quite difficult to have an anticipatory critical post-appointment process if you only have a general post-process. The Western Cape seems to do that upfront. They can immediately align the funds to the number of posts they can afford. And they do that upfront.”