Saturday 24 February


18 February 2022, Johannesburg – Following a recent audit report commissioned by the Provincial Department of Health into the high COVID-19 mortality rate in the Eastern Cape, the Eastern Cape Health Crisis Action Coalition (ECHCAC) urges the Eastern Cape Department of Health (ECDoH) to provide the implementation plan determined by the Office of the Public Protector as part of its remedial action. In the interest of transparency, the ECHCAC also urges the department to respond to its PAIA application to obtain a report initiated by the National Department of Health in 2020 and the strategic planning records on the province’s readiness to tackle the COVID-19 pandemic.

The audit report paints a devastating picture of the state of the healthcare system in the province, detailed in a series of articles published by the Daily Maverick. It also revealed that 30% of COVID-19 patients delayed in presenting themselves to hospitals, with 82% admitted from home. The reporting regarding patient assessments was wholly inadequate, with many of the assessment reports being missed, sub-standard or inadequate.

In 31% of the cases considered, it was determined that absence of the necessary equipment needed to provide life-saving oxygen therapy led to the death of patients. This lack of equipment prevented the proper oxygen escalation plans from being followed for COVID-19 patients whose oxygen saturation levels were dropping. The escalation to different oxygen therapy is necessary if the initially administered oxygen therapy does not relieve the patient’s symptoms.

The report also identified the endemic human resource challenges resulting in nursing shortages, leaving community service practitioners to manage cases without supervision. Staffing shortages were due to resignations with no replacements, staff contracting the virus and isolating at home, burn-out and fatigue; the stigma around COVID-19 at the time played a role in the inadequate care of patients. The report also found that shortages in general workers led to workload increase for nursing and medical staff.

Furthermore, those who live in the rural parts of the province are most likely to be affected by the ECDoH’s inability to meet the needs of the people it serves. The ECHCAC notes that the report shows a higher rate of mortality recorded in the hospitals that served the more rural parts of the Eastern Cape compared to the hospitals in the urban areas. The length of stay at the hospital (admission to death) days was longer for patients in urban areas than in rural areas.

This discrepancy illustrates the catastrophic consequences of the inaccessibility of emergency medical services in rural areas. The report revealed records of patients seeking hospital services late, partly due to a lack of knowledge of the COVID-19 pandemic interventions. And lack of emergency medical transportation to get patients to hospitals timeously was also a factor.

The results of the audit are shocking but not unexpected. The systematic challenges faced by the Eastern Cape are historic. Our member organisations have been working diligently for many years, to draw attention to them and to recommend changes. In the absence of an intervention, the devastation suffered by the Eastern Cape people during the pandemic was inevitable.

The series of interventions that have occurred in the past sounded a death knell to the loss of life that occurred in the province because of the delta variant. With so many forewarnings issued, the blame cannot be placed at anyone else’s feet but the ECDoH.

In September 2013, the ECHCAC released a report entitled; “Death and Dying in the Eastern Cape: An investigation into the collapse of the health system”. The report painted an accurate and worrying picture of the state of the provincial health system. Some aspects covered included the sporadic availability and, in many instances, the complete unavailability of ambulances in rural areas of the Eastern Cape.

In 2015, the South African Human Rights Commission (SAHRC) held public hearings and published a report entitled; “Access to Emergency Medical Services in the Eastern Cape”. The ECHCAC provided evidence to the Commission on the issues regarding accessing ambulances. In its findings, the SAHRC detailed the inadequacy of the emergency medical services offered by the ECDoH and documented the challenges faced by the ECDoH regarding the provision of emergency medical services. It also concluded that the number of operational ambulances in the province was grossly insufficient and could not be expected to service the population of the Eastern Cape. Unfortunately, the situation has not improved much since.

In 2016, ECHCAC wrote a series of letters to the ECDoH to engage the department in its response to the SAHRC’s findings. However, the department’s response that it did not have the resources necessary to service the most basic health needs in the province left much to be desired.  

ECHCAC members have long engaged the ECDoH on the province’s issues around the accessibility of medication, challenges with human resources, constraints related to the availability of PPEs and EMS. It is disappointing that long-standing matters led to the death of so many. This level of death and destruction was avoidable.

The ECDoH is fast moving through the different mechanisms to hold it accountable for the collapse of the provincial healthcare system. At least two chapter nine institutions have engaged the department and statutory mechanisms have been unsuccessful in invoking access to records that should already be in the public domain. All this is done with impunity towards the loss and impairment of life and the infliction of irreversible suffering on some of the most vulnerable people in society.

Although the most recent COVID-19 wave has subsided, the continued state of collapse of the healthcare system remains a present reality for healthcare users and the ineptitude and lack of political will of the ECDoH will continue to result in the loss of lives.  


For media queries, contact: 

Patience Phiri ( 072 992 8380)