Attention: Mr Hope Papo

MEC for Health

Gauteng Department of Health

By Fax:  011 355 3259


14 March 2013



Dear MEC Papo


On 4 March 2013, SECTION27 and the Treatment Action Campaign (TAC) released a joint report “Monitoring our health: an analysis of the breakdown of health care services in selected Gauteng facilities.” A hard copy was provided to your office on Friday, 1 March 2013.  A media statement issued by your office on 4 March 2013 in response to our report makes several statements that warrant a response.


You note that you would have liked an opportunity to engage with the authors of the report prior to it being published. It is therefore important to note that SECTION27 and TAC have, in fact, engaged with you on the issues raised in the report since you were appointed as MEC for Health in July 2012, through correspondence, meetings and in the media.  We also previously engaged with MEC Mekgwe, your predecessor, and the Premier of the province on problems in the delivery of health care services in Gauteng. It is disingenuous to request engagement through a media statement when to date, despite providing both hard and electronic versions of the report we still have not had an acknowledgement of receipt from your office nor any direct response. In addition, a letter to your office sent in response to your press statement over a week ago has not been acknowledged or answered.


Your media statement points to a number of improvements undertaken by the Gauteng Department of Health (GDoH) in the four central hospitals. It suggests that the GDoH has since resolved the problems outlined in the report. While we applaud the GDoH for the efforts it is making to improve accountability and budgeting, as well as to improve the functioning of state facilities we believe that it is too early to claim resolution of these problems. Since our report was released on 4 March 2013, TAC and SECTION27 have received many emails and calls from healthcare workers who state that our report is a true reflection of the state of health in the Province. In addition, we  still receive complaints related to the same issues we highlight, with respect to shortages of medicines and consumables, broken equipment, and inadequate human resources across primary, district, tertiary and central hospital faciliites.  Below are just a few examples:


  •  Thokoza Phenduka clinic in Ekhurhuleni had no ARVs last week. Patients reporting to the clinic were given prescriptions instead of medicines and told to buy ARVs at a pharmacy in Alberton.
  • Last week, Chris Hani Baragwanath Academic Hospital (CHBAH) was out of Simvastatin (Zocor), a medicine that is critical for cholesterol lowering and is used in patients at risk of stroke and heart attack. Stocks of Simvastatin later became available but other critical items such as alcohol disinfectant were unavailable in many wards. This is a basic necessity for infection control and the absence thereof is a threat to patients’ health.
  • A four hour power failure at Charlotte Maxeke Johannesburg Academic Hospital this week nearly resulted in a catastrophe when back-up generators serving the main ICU did not function. Doctors serving the main ICU had to prepare for manual ventilation as the batteries on ventilators reached critical levels.
  • We have first-hand testimony from healthcare professionals at a large district hospital that the GDoH’s refusal to pay for overtime due to irregularities in overtime claims has led to staff shortages and has directly resulted in patient deaths. It is vital to clamp down on corruption and irregularities but austerity measures should not be at the cost of patients’ health and lives.


With respect to addressing some of the underlying problems in the system, we congratulate you now that a large proportion of the outstanding debts have been paid. However, we remain concerned about the effects of the payment of those accruals with the current budget.

In November 2012, the Budgeting and Expenditure Monitoring Forum (BEMF), a coalition that we are part of, wrote to you raising concerns about the source of funds used for the payment of these debts and your plan to address the GDoH’s non-compliance with the Public Finance Management Act. We received no response.  These issues are critical to the future sustainability of the health system and must be publicly addressed by yourself, particularly in light of the additional funds that have been allocated to the GDoH in the next budget cycle.


We want to work with you to fix the health system. So do health care workers and people who depend on the facilities you are responsible for. But this requires honesty, transparency and accountability. We therefore call on you to convene a Provincial health consultative council, a body that is legally required by the National Health Act to “promote and facilitate interaction, communication and the sharing of information on provincial health issues”. As MEC you are required by law to establish such a forum and convene it at least once a year. This body is far more suitable as a platform for engagement, accountability and joint action.


TAC and SECTION27 try to speak for users of the health system. We are trying to tell you what they tell us. We will always be available for discussion and engagement. However, it is clear that we have very different experiences of the public health sector. We therefore invite you to take a glimpse into the public health system as seen by patients and doctors by joining members of the TAC and visiting facilities, not officially as the MEC but incognito, as an ordinary member of the public. That way you will observe how patients really experience the health care system.


SECTION27 and the TAC are committed to continued monitoring of the state of delivery of health care services in facilities around Gauteng in future and we will continue to publicise our findings in the interests of the public.



Yours sincerely

Mark Heywood                     Nonkosi Khumalo

SECTION27                              Treatment Action Campaign