The public health sector is in such a dire state and work to raise standards is progressing so slowly that most facilities won’t make the grade to provide services under National Health Insurance (NHI), the health ombud warned parliament on Wednesday.
NHI is the government’s plan for universal health coverage and aims to ensure everyone can obtain services that are free at the point of delivery. Its first piece of enabling legislation, the NHI Bill, is before parliament and proposes that a central fund purchase services from public and private health facilities, which must first be inspected and accredited by the Office of Health Standards Compliance (OHSC).
“As things stand today we couldn’t go into the NHI with the level of inspections and certification we have done so far, because I suspect most of the hospitals will not meet the high standard required of the NHI,” health ombud Malegapuru Makgoba told parliament’s portfolio committee on health.
Makgoba was appointed health ombud in 2016 and has overseen a series of high-profile investigations into failings in the public health sector.
Makgoba said he visited all the provinces in the past year and found deteriorating health services in all but the Western Cape. “Whilst we are preparing for NHI, we don’t seem to be raising the standards [of] the service we are giving to the population in SA.
“The only province that seems to have its act together is the Western Cape ... The other provinces are really in difficulties and need ... to jack up their work,” he said.
The OHSC works closely with the office of the health ombud, and both have consistently complained to parliament that they are unable to fulfil their mandate because they are under-resourced. The OHSC says in its five-year plan that it aims to inspect each of SA’s more than 5,000 health facilities at least once every four years, meaning it needs to assess on average 1,200 a year.
It inspected only 544 out of SA’s 3,741 public health facilities in the year to March 31, slightly up on the 387 it scrutinised the year before. No private health facilities were inspected because their assessment criteria have not yet been finalised.
OHSC CEO Siphiwe Mndaweni said the coronavirus pandemic had delayed inspections for the past two fiscal years. These challenges were layered over budget and staff constraints that limited the number of facilities that could be inspected and contributed to delays in resolving complaints, she told MPs as she presented the OHSC’s 2021/2022 report. The complaints directorate has only three staff, she said.
Only 39 of the 146 complaints received from patients of health facilities were resolved within the OHSC’s 30-day target. Seven of the 158 serious complaints that warranted an investigation were completed in its six-month target, and two were resolved within a year.
DA health spokesperson Lindy Wilson, who is a member of the committee, said the OHSC did not have the resources to do its job properly.
It “is not making a dent in the situation at all. There is no improvement in health. It is actually declining,” she said. “It is not entirely their fault.”
The OHSC is entirely funded by the fiscus and was allocated R160m in 2021/2022. It reported an operating surplus of R11m, taking its accumulated surplus to R65.8m, and received an unqualified audit.
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