Budget cuts implemented by the National Treasury hobble the efforts of provincial health departments to fill posts, placing strain on staff and forcing patients to wait longer for care, health minister Aaron Motsoaledi has told parliament.
All the provinces were scrambling to deliver services with fewer doctors, nurses and senior managers, he said in a written response to questions from Action SA MP Kgosi Letlape.
Vacancy rates for doctors ranged from 22.4% in the Free State to 5.5% in the Western Cape, while those for nurses ranged from 28% in the Free State to 5% in the Eastern Cape, he said.
More than two-fifths of senior management positions in the Northern Cape stood empty. The Eastern Cape, the Free State, KwaZulu-Natal and Mpumalanga reported that about a quarter of their posts for senior managers were unfilled.
The budget in February set aside a consolidated health amount that grows by a nominal 3.4% over the medium term. This was below the Treasury’s estimate that inflation would average 4.7% over the next three years, meaning the budget shrinks in real terms.
Motsoaledi’s reply to Letlape comes as the Treasury finalises October’s medium-term budget policy statement. Provinces will be looking for relief from budget pressures in all front-line services, including education. Provincial education departments told MPs last month that thousands of teacher posts are to be cut due to lack of funds.
The reduction in the headcount increased the workload for remaining staff, leading to higher stress and decreased job satisfaction, said Motsoaledi.
He told MPs that the remaining staff “continue to provide good quality clinical services”, but having fewer personnel negatively affected the number of patients that could be attended to.
In addition to the funding crisis, provincial health departments faced the challenge of shortages in professional categories such as ophthalmologists, psychiatrists, theatre nurses and ICU nurses, said Motsoaledi.
Letlape said the high vacancy rates told only part of the story as they did not reveal the number of doctors and nurses needed by the local population.
“The question is: what is the gap between needed posts and funded posts? The funded posts are just those they [provincial health departments] have budget for. If you have a 5% gap in funded posts, but a 50% gap between needed and funded posts, [it is] woefully inadequate for your responsibilities,” he said.
Staff shortages created a deeply stressful work environment for healthcare professionals, he said. “It affects their mental health, their work-life balance, and their family time. They end up being impatient and shouting at patients. It is a hostile environment and it is bad for the morale of workers and bad for patient care,” he said.
“We need to create an environment conducive to quality health services so healthcare professionals are attracted [to the public sector] and can live up to their oath and promise to the population,” he said.
Western Cape health and wellness MEC Mireille Wenger said the ratio of healthcare professionals to population provided a better measure of staffing constraints than vacancy rates.
The province’s ratio of doctors and nurses to population had worsened, as budget adjustments had not kept pace with population growth, said Wenger.
“The current budget cuts mean that public healthcare expenditure per capita in 2023 in SA was less than in 2017. This is exacerbated when centrally negotiated wage deals are not fully funded by the national government,” she said.
The Treasury finalised the February budget before the government reached a wage deal with public servants in April that was higher than expected.
Update: September 10 2024
This story has been updated with comment from Kgosi Letlape and Mireille Wegner.
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