Tag: Gauteng Department of Health

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What Next for Cancer Patients as Court Again Rules Against Gauteng Health Department?

On By ModernMedia
Photo by Bill Oxford on Unsplash

By Ufrieda Ho

In the latest chapter of a long-running legal battle over the Gauteng Department of Health’s obligation to provide people in the province with radiation oncology services, the department has suffered another loss in the courts. Spotlight assesses the legal situation and asks what it means for people still waiting for the life-saving treatment.

With another court loss suffered this August, the Gauteng Department of Health has once again been ordered to urgently provide treatment for cancer patients who have been left in the lurch.

This ruling, handed down on August 5 by Judge Evette Dippenaar, follows urgent legal action brought by the Cancer Alliance. It was in response to the Gauteng health department’s appeal against a ruling handed down on March 27 by acting Judge Stephen van Nieuwenhuizen. That order compelled the department to clear its years-long backlogs in getting cancer treatment to patients.

In its March ruling, the South Gauteng High Court in Johannesburg found the department’s failure to deliver this critical treatment to be unconstitutional and unlawful. The decision follows the department’s failure to spend a R784 million allocation granted by the provincial Treasury in 2023 to reduce the treatment backlog by outsourcing services to the private sector over a three-year period. Due to severe delays, the department was forced to return the first R250 million tranche.

Van Nieuwenhuizen strongly criticised the department, stating: “The provincial health respondents have done nothing meaningful since the money was allocated in March 2023 to actually provide radiation oncology treatment to the cancer patients. Meanwhile, the health and general well-being of the patients has significantly deteriorated. There is clear, ongoing, and irreparable harm being suffered by those still waiting for treatment.”

He also condemned the department for its lack of accountability and poor management of public resources, finding that it had failed to uphold ethical standards, act transparently, or respond to patients’ needs fairly and effectively.

The court instructed the department to:

  • Take immediate action, including diversion to private facilities, to provide radiation oncology services to all patients on the backlog list,
  • Update the backlog list within 45 days,
  • Submit a detailed progress report on efforts to deliver treatment, and
  • Present a long-term plan for ongoing cancer treatment services within three months.

But Gauteng health MEC Nomantu Nkomo-Ralehoko and the health department challenged the judgment in May, just as their 45 days to act ran out. They chose instead to take the entire matter on appeal to the Supreme Court of Appeal (SCA).

In response, the Cancer Alliance, represented by SECTION27 (*see disclosure), went back to court for an interim order to make the March 27 ruling immediately enforceable, and not suspended until a ruling is made by the SCA. It is in response to this application that Judge Dippenaar ruled on August 5 that the March ruling is indeed immediately enforceable.

Two courts have now sent a clear message to the Gauteng health department, says attorney Khanyisa Mapipa, who heads health rights at SECTION27. She adds: “The Gauteng Department of Health’s action should be in the interest of the person who is seeking treatment. It should not be to deny, deny, deny and then to fight in the courts and not take any accountability.”

The waiting list

The estimated number of people on a waiting list for cancer treatment in 2022 was around 3 000 people. New data on this has not been made publicly available.

There are some signs of progress, although details are hard to pin down. In a statement released on August 24, which reiterates a July 20 statement, the Gauteng health department said it had introduced a strategic partnership with private service providers. “As the beginning of August 2025, 563 patients were receiving radiation oncology care through private partnerships, while 1 076 patients had completed treatment by end of July 2025,” it stated.

Both statements also noted that work was underway to complete new radiotherapy centres at Chris Hani Baragwanath and Dr George Mukhari Academic Hospitals.

But Mapipa says they still don’t have full details that comply with the court order. “What we’re asking for essentially is what the department should be doing anyway and that is for them to go through their patient files to establish who is still on the backlog list; who has passed away, who has received treatment, when patients were last assessed and what treatment they qualify for; and if it was a public facility or were they diverted to a private facility,” she says.

“As the judge pointed out in March, the department has to do this as a constitutional obligation, whether they fight this to the Constitutional Court or not, their obligation is to provide treatment for people who meet the criteria. Those on the backlog list meets the criteria,” she says.

Part of the March order also compelled the department to file progress reports with the court within three months on the measures taken to provide treatment and its long-term plans to resolve the ongoing cancer treatment crisis in Gauteng. Spotlight’s understanding is that these progress reports have not been submitted.

This is an important measure, Mapipa says, given the department’s poor track record. “The court rulings in both judgments found that because they have failed to be transparent throughout this process, the department is compelled to provide these reports to the courts,” she adds.

It is as yet unclear how the Gauteng health department plans to proceed. The department, in its three-paragraph statement following the August judgment, stated that it would review “the contents and implications” to determine and communicate its next steps. Their deadline to appeal the August 5 ruling was 26 August 2025. The department did not respond to questions from Spotlight.

Calls for accountability

Jack Bloom, Democratic Alliance shadow health MEC in Gauteng, says that without a proper audit and update of the backlog list of patients needing care, the “cancer treatment scandal has probably cost more lives than the 144 mental patients who died in the Life Esidimeni tragedy when they were sent to illegal NGOs”.

Bloom is calling for heads to roll, with Nkomo-Ralehoko and head of department Arnold Lesiba Malotana in his crosshairs.

“The DA condemns the department’s legal stalling tactics that harms patients who urgently require lifesaving treatment…Premier [Panyaza] Lesufi should not allow this cancer disaster to continue,” he says.

Salomé Meyer, spokesperson for Cancer Alliance, says that the legal proceedings are a distraction of the realities on the hospital floor. Charlotte Maxeke Johannesburg Academic Hospital for instance, she says, remains in “crisis”. She maintains there is a scarcity of sufficient and operational radiation oncology machinery, as well as extreme shortages in radiation oncology staff to operate the machines.

Meyer says the situation at Charlotte Maxeke Hospital dates back to 2017 when CEO Gladys Bagoshi was made aware of mounting challenges from a shortage of equipment and staffing.

“In 2021, Bagoshi turned down an equipment allocation, which Charlotte Maxeke Hospital desperately needed, so this allocation went to George Mukhari Hospital and Chris Hani Baragwanath Hospital instead. But the cobalt bunkers required to house the machines at these hospitals had not been built and are only expected to be completed in 2026 – so the machines remain in storage. In 2022, an order was finally placed for additional linacs [used for high energy beam radiation treatments] for the existing cobalt bunkers at Charlotte Maxeke Hospital, but that tender is still not finalised,” says Meyer.

She adds: “This is a failure of planning, governance, and accountability and we have to ask who is being held accountable when the same CEO has remained in place all these years.”

Neither Bagoshi nor the health department responded to questions on these assertions.

Disclosure: SECTION27 was involved in the court proceedings described in this article. Spotlight is published by SECTION27, but is editorially independent – an independence that the editors guard jealously. The Spotlight editors gave special attention to maintaining this editorial firewall in the production of this story.

Republished from Spotlight under a Creative Commons licence.

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Questions Over Tripling of Gauteng Health’s Security Budget

On By ModernMedia
Photo by Markus Spiske on Unsplash

By Ufrieda Ho

In just two years, the Gauteng health department’s spending on security has more than tripled. We try to get to the bottom of the ballooning bills and what it means for governance in the department.

The Gauteng Department of Health’s projected R2.54 billion spend on security contracts for 2025/2026 has received the thumbs up, fuelling suspicion in various quarters. It comes as the department claims to lack the funds to fill vacancies, pay all suppliers on time, or continue fulfilling doctors’ overtime contracts.

The R2.54 billion is more than three times the R838 million the department spent two years earlier in 2023/2024. This was revealed at the end of May in response to questions raised in the Gauteng Legislature by the Democratic Alliance (DA), the official opposition in the province. In 2024/2025, the department’s security spending was just over R1.76 billion.

Jack Bloom, the DA’s shadow MEC for health in Gauteng, calls the proposed expenditure “unjustified”, given that the department is failing to meet its health service delivery targets.

According to him, security companies charge R77 million per year for guarding services at Chris Hani Baragwanath Hospital, and over R72 million annually at Charlotte Maxeke Hospital.

At Tara Hospital, the new security contract costs R14 million per year – a sharp increase from the previous year’s R4.2 million contract, which had provided 21 guards for the facility. Bloom says that, according to the department’s own assessment, only five additional guards were needed at Tara Hospital, increasing the total to 26. However, the current contract pays for 46 guards. “This means they are paying about R5 million a year for 20 guards they do not need,” Bloom says. “They could better use this money to fill the vacancies for 13 professional nurses, as Tara Hospital cannot use 50 of its 137 beds because of staff shortages. It is a clear example of excessive security costs squeezing out service delivery,” he says.

    “The numbers simply don’t add up,” Bloom says. He points out that the written responses provided in the Gauteng Legislature – signed off by MEC for Health and Wellness, Nomantu Nkomo-Ralehoko – cite an internal security assessment and compliance with Private Security Industry Regulatory Authority (PSIRA) salary increases for guards as reasons for the higher costs. However, the internal assessment has not been shared with either Bloom or Spotlight, despite requests from both.

    The PSIRA-approved annual increase is 7.38%. In contrast, the department’s security spending rose by over 100% from 2023/2024 to 2024/2025, and it’s projected to increase by another 40% from 2024/2025 to 2025/2026.

    According to a statement released by the Gauteng health department in April 2024, it had 113 security companies under contract at the time, providing a total of 6000 guards across 37 hospitals and 370 clinics and institutions in the province.

    ‘Very fishy’

    Bloom says security guarding contracts have been “very fishy for at least the past 10 years”. He claims: “There are certain security companies that keep popping up. These companies will get two-year contracts, then have their contracts extended for something like 10 years. Then we have these new contracts which have soared in costs. The auditor general has said that there is irregular expenditure. Security contracts have always been suspect and have always been corruption territory.”

    In March this year, the DA lodged a complaint with the Public Protector over a R49 million guarding contract for five clinics in Tshwane and the MEC’s offices. The contract was awarded to a company called Triotic Protection Services. The DA alleges that the company was founded by City of Tshwane’s deputy executive mayor, Eugene Modise, who also previously served as its director. When the company was awarded the contract, it was allegedly in the crosshairs of the South African Revenue Service because it owed R59 million in tax over five years. This has raised concerns about the company’s tax compliance status and its eligibility to tender for the contract. Spotlight approached Modise for comment through Samkelo Mgobozi, spokesperson for the office of the executive mayor, but had not received a response by the time of publication.

    Other security companies that have contracts with the department have also made headlines for allegedly flouting labour laws. These include not paying guards for months and withholding employees’ pension and provident fund contributions. It leaves questions about due diligence and the proper vetting of companies.

    A review underway?

    In the weeks since Bloom’s questions were answered in the legislature, he says Nkomo-Ralehoko conceded to a review of the security spend at the province’s hospitals.

    However, the Gauteng health department has not announced anything formally and no further details have been provided.

    The department has also not responded to Spotlight’s questions or provided supporting documentation of their assessment criteria for the security contracts, the tender requirements, tender processes and how they measure value for money and the impact of increased guarding in improving safety and security for patients, staff and visitors to its hospitals. They have also not made available a list of the companies with successful contracts and what their services entail.

    As Spotlight previously reported in some depth (see here and here), there are serious security problems at many health facilities in Gauteng. It ranges from cable theft disrupting hospital operations to healthcare workers being assaulted. The department has also been criticised from some quarters for its plans to train healthcare workers to better handle violent situations.

    That steps need to be taken to better secure the province’s health facilities is not controversial. But our previous reporting has also shown a pattern of questionable contract management, with, for example, contracts being extended on a month-to-month basis for years after the original tenders had technically expired. It appears that the widespread use of these month-to-month security contracts came to an end when the department finally awarded a series of new security tenders in 2024 but it also seems likely that these new contracts are driving the department’s ballooning security spending.

    ‘Has to be justified’

    The department’s massively increased security spend must be fully explained and is essential for transparency, say several experts Spotlight spoke to.

    “This kind of escalation in cost has to be justified, especially when the department has no money,” says Professor Alex van den Heever, chair of social security systems administration and management studies at the University of Witwatersrand.

    He says the specifics of the tender process and the contracts that were awarded need to be publicly available to be openly scrutinised. The processes must meet Treasury’s procurement guidelines and must follow the Public Finance Management Act, which regulates financial management within the national and provincial governments. Where there is wilful non-compliance, Van den Heever says criminal charges should be laid.

    “This is a department that has routinely had around R3 billion a year in irregular expenditure. It means procurement procedures have been bypassed. This is not an isolated incident; it’s systematic,” he adds.

    The latest Auditor General report into the Gauteng health department was released in September last year for the 2023/24 financial year. It showed that of its R60 billion budget, the department underspent by R1.1 billion, including R590 million on the National Tertiary Service Grant that was meant to help fund specialist services. The report highlighted R2.7 billion in irregular expenditure, which is R400 million more than the previous year, and R17 million in fruitless and wasteful spending – an increase of R2 million from the year before.

    Equally damning, the report highlighted the lack of credible information provided. “This is likely to result in substantial harm to the operations of the department as incorrect data is used for planning and budgeting and the effectiveness of oversight and monitoring are reduced as a result of unreliable reported performance information on the provision of primary healthcare services,” wrote the Auditor General.

    Van den Heever says the leadership and management within the health department need to be seriously questioned. Questions should be asked of why “bad apples” are not being removed, why there are no consequences for conflicts of interests and collusions, and why webs of enablers within the department are not exposed for insulating wrongdoers, he says.

    Van den Heever says that over nine years of monitoring, the Gauteng Health Department’s irregular and wasteful spending ranged between 3.6% and 6.6% of its total budget. In contrast, during the same period, the Western Cape’s irregular spending ranged from 0% to just 0.1%.

    Lack of transparency

    The Gauteng health department’s spike in security spending demands deeper investigation, says Advocate Stephanie Fick. She is executive director for accountability and public governance at the Organisation Undoing Tax Abuse and serves on the Health Sector Anti-Corruption Forum. This forum was launched in 2019 as an initiative to combat corruption within the healthcare system. It falls under the Special Investigations Unit and brings together a range of stakeholders, including law enforcement agencies, government departments, regulators, and the private sector.

    Fick says the health department’s failure to provide easy access to information on tenders, contracts, and contracted companies undermines transparency and accountability. She encourages more people to come forward with insider information.

    “We want to see the details right down to line items and who signed off on things. We encourage people to use our protected whistleblower platforms to share information,” Fick says.

    “For civil society, there is a growing role to mount strategic challenges to things like this kind of excessive and irregular expenditure; to demand transparency and to expose people who are responsible.

    “This must be done so ordinary people can better understand what’s been happening with their tax money and so they choose more carefully when they go to the ballot box, starting with next year’s municipal elections,” she says.

    Republished from Spotlight under a Creative Commons licence.

    Read the original article.

    Categories : Cancer Ethics and LawTags :

    Court Orders Gauteng Health Department to Treat Cancer Patients

    On By ModernMedia

    Judge rules failure to deal with backlog of patients needing radiation treatment is unconstitutional

    By Liezl Human

    Photo by Bill Oxford on Unsplash

    The Gauteng Department of Health is appealing against a judgment by the Johannesburg High Court ordering it to provide radiation oncology treatment to a backlog of nearly 3000 cancer patients at Charlotte Maxeke Hospital and Steve Biko Hospital.

    In April last year, activists from SECTION27, Cancer Alliance and the Treatment Action Campaign (TAC) joined cancer patients to march to the department’s provincial office, demanding that millions of rands set aside for radiation treatment be used.

    The matter was then taken to court by the Cancer Alliance, represented by SECTION27, after years of attempts to engage with the department about radiation services. They said in a statement they wanted the court to compel the department to provide treatment to the backlog of cancer patients still waiting.

    Some patients have been on the list for nearly three years, while others have died while waiting, according to the judgment by Acting Judge Stephen van Nieuwenhuizen. He noted that “irreparable harm” has occurred and continues to occur in the absence of treatment.

    He said the backlog, of mostly Charlotte Maxeke patients, had grown due to a lack of radiation equipment at the hospital and a shortage of staff. This was in spite of an allocation of R784-million over three years, specifically ring-fenced for radiology oncology services. The allocation was also meant to help clear the backlog of patients.

    Delays in finalising a tender for these services meant that R250-million was returned to National Treasury at the end of the fiscal year, he said.

    The judge found that the provincial department had infringed on the rights of these cancer patients in that a high standard of professional ethics had not been maintained. “Efficient and effective use of resources were not promoted. Services were not provided impartially, fairly, equitably and without bias.”

    Judge van Nieuwenhuizen said the provincial health department had done “nothing meaningful” since the money was allocated in March 2023 to actually provide radiation oncology treatment to the cancer patients. “On the other hand, the health and general well-being of cancer patients has significantly deteriorated. There is a clear, imminent and ongoing irreparable harm that cancer patients who are on the backlog list are suffering.”

    The judge ruled that the department’s failure to provide radiation services to cancer patients on the backlog list was unconstitutional and unlawful.

    He added that the provincial health officials “have conducted themselves as a law unto themselves” and ordered that measures be put in place to ensure officials are “held to account for their constitutionally imposed obligation to provide healthcare services … to cancer patients who are on the backlog list”.

    He also ordered that the list of cancer patients still awaiting radiation treatment must be updated within 45 days and that a progress report and long-term plan must be submitted to the court within three months.

    Salomé Meyer, director of the Cancer Alliance, told GroundUp the ruling would allow the court to get accurate information on the circumstances of each patient still waiting for treatment.

    She said the judgment “confirms that civil society has a role to play to hold the government responsible for what it is supposed to do”.

    In a statement on 2 April, the department confirmed that it had filed an application for leave to appeal against the ruling. The department said “there are several substantive grounds of appeal, which if left unchallenged will be greatly prejudicial to the patients undergoing radiation oncology services at the hospitals” and might set an “undesirable” precedent.

    Republished from Groundup under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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    Critics Raise Alarm over Leadership Issues at Gauteng Health Department

    On By ModernMedia
    Nomantu Nkomo-Ralehoko is the MEC for Health and Wellness in Gauteng. (Photo: GautengHealth/X)

    Several opposition politicians and commentators have flagged what appears to be chronic leadership problems at the Gauteng Department of Health.

    Criticism of leadership and governance at the Gauteng Department of Health (GDOH) is amping up as the department repeatedly makes headlines for questionable appointments. This unfolds alongside a damning auditor-general report, all while hospitals and clinics across the province grapple with ongoing challenges.

    Arguably, the most controversial appointment is that of Arnold Malotana. He was quietly named head of department shortly after the May 29 national elections, following a year of serving in an acting capacity. Malotana has been with the department in various positions since 2008, according to his LinkedIn profile.

    SIU investigation

    Malotana has been implicated in a case being investigated by the Special Investigating Unit (SIU). It relates to the alleged manipulation of supply chain processes in 2016 and 2017 in favour of a company called BAS Medxpress (BAS Med). It has been alleged that Malotana and two senior officials – Edgar Motha and Sheriff Lecholo – took bribes to the tune of R8 million. The case made headlines a year and a half ago when amaBhungane lifted the lid on an affidavit from a whistleblower, who himself was part of the alleged tender-rigging scheme. The SIU investigation was however only ordered by presidential proclamation this November. According to amaBhungane’s reporting last year, all those implicated in the matter have denied wrong-doing.

    SIU spokesperson Kaizer Kganyago said the probe will focus on two supply contracts – one for plastic containers and another for orthopaedic instruments – to determine if any actions broke laws, policies, or Treasury or health department rules, and whether they may be fraudulent.

    “Such conduct may include manipulation of the department’s supply chain management processes by service providers, suppliers, officials, or other third parties, often in collusion with departmental employees or those in entities under its control, to secure undue benefits for themselves or others. This can result in unauthorised, irregular, or fruitless and wasteful expenditure incurred by the department, its entities or the State,” he said in a statement.

    Questions over qualifications

    Malotana has also been under separate investigation regarding his qualifications when his appointment as head of department was made. His LinkedIn profile lists his education as two years (2013 – 2014) at the Durban Institute of Technology and a master’s degree in public management from Regenesys Business School, with no dates provided.

    Earlier this year, Jack Bloom, a DA member in the provincial legislature, wrote to the Public Protector to ask that they investigate Malotana’s appointment. Public Protector passed the matter to Parliament’s Portfolio Committee for Public Service and Administration. In turn, the committee chair requested the Public Service Commission (PSC) to investigate.

    In mid-November, the PSC “reportedly” cleared Malotana on the allegations relating to his qualifications and appointment. The PSC report was leaked to The Star newspaper with the complainants – the DA – as well as the portfolio committee chairperson not yet having had sight of the report. Spotlight also hasn’t yet been able to access a copy.

    According to The Star, the PSC found that a master’s degree was not explicitly listed as a required qualification, and as a result, the commission found that Malotana did meet the requirements.

    Bloom told Spotlight: “It’s highly irregular that the PSC report is leaked to a specific newspaper.”

    Meanwhile, the SIU investigation continues, and the DA has reiterated its call for Gauteng Premier Panyaza Lesufi to remove Malotana from his post. Heads of departments are appointed by provincial premiers.

    The Office of the Premier did not answer Spotlight’s questions about Malotana or the SIU investigation. However, according to a statement from the DA, Lesufi said in a Gauteng Legislature meeting last week that he would wait for the SIU investigation to be completed before taking any action against Malotana.

    Millions spent on suspended staff

    In September, responses to questions posed by Bloom in the Gauteng Legislature revealed that the provincial health department spent over R13 million on salaries for nine suspended staffers in recent years. Among these were Advocate Mpelegeng Lebeloane, former chief director of legal services, who received R4.7 million while on suspension from July 2019 until 2023. He was later reinstated and then retired in July 2024.

    Bloom said in a statement at the time: “Three senior staff were suspended since 26 January 2022 for alleged financial misconduct concerning the refurbishment of the Anglo Ashanti Hospital. One has recently resigned, but more than R6 million has been spent so far on their salaries in this inexcusably long-running matter.”

    The other staff members had been suspended on a range of charges, including sexual assault, assault and a job-selling scam.

    Bloom said the long delays in concluding disciplinary processes smacked of a failure of accountability and were a drain on taxpayers’ monies and resources.

    Spotlight put questions to the health department about its mechanisms and processes to ensure efficient and appropriate disciplinary action. The department’s spokesperson Motalatale Modiba said the cases in question “cut across various departments”. He added: “The employees were suspended with full pay and the delays mainly had to do with ongoing SIU investigations.” This includes cases that were “handled through the Office of the Premier”.

    Hospital CEOs

    Also on Bloom’s radar are the appointments of Dr Nthabiseng Makgana, Dr Lehlohonolo Majake, and Dr Godfrey Mbara to positions of CEOs of Chris Hani Baragwanath, Steve Biko and George Mukhari academic hospitals respectively.

    The appointments were made in March, and health MEC Nomantu Nkomo-Ralehoko responded to Bloom’s questions about them in October. Bloom highlighted irregularities, noting that none of the three appointees met the requirement of 8 to 10 years of experience for hospital CEO roles, while one also didn’t have the required education qualification level. These are contraventions of regulations, according to Bloom, adding that he is still to see proof of qualifications, as he’s requested.

    Another high-profile appointment under scrutiny has been the redeployment of Dr Nozuko Makabayi – the former CEO of the Rahima Moosa Mother and Child Hospital. A doctor’s open letter in June 2022 exposed poor conditions at the hospital, leading to a Health Ombud investigation. The damning report criticised Makabayi for several failings, including being absent from work for nearly 100 days without explanation. The Ombud recommended that Mkabayi be removed as CEO, but she was shifted within the department to serve as acting director responsible for HIV and Aids, STIs and TB.

    Bloom’s follow-up questions to Nkomo-Ralehoko brought to light that Makabayi has not been reporting for work, due to mental health stress, but continues to receive her salary. “This is outrageous. After all the trouble she caused, she is now on a long running paid holiday at taxpayers’ expense. If she can’t do any useful job, she should be medically boarded and leave the department,” he said in October.

    “There has not been a permanent HR director for years in the department and the systems of appointments follow a consistent pattern of people placed in acting positions, protecting interests, and ensuring cadre deployment rather than service delivery,” Bloom told Spotlight.

    “We have the wrong people in these key positions by design. We are talking about control, looting and siphoning of one of the largest budgets in the province,” he alleged.

    Modiba said that “relevant bodies are investigating” and pertaining specifically to Makabayi, he said “internal processes are unfolding” but cannot be released to the media because of an “employer-employee clause”.

    Scathing Auditor General report

    Recently, the Gauteng Department of Health received another scathing report from the Auditor-General for the 2023/24 financial year.

    The department underspent by R1.1 billion, including R590 million underspent on the National Tertiary Service Grant intended for specialised medical treatment. This in spite of backlogs and long patient waiting lists. In addition, the report showed that the health department racked up R2.7 billion in irregular spending, R17 million in wasteful spending, and lost another R2.7 billion in income.

    Action SA member in the provincial legislature Emma More described the performance of the department as “clearly lacking effective leadership and management”.

    She slammed the health department for providing incorrect and misleading statistics, as highlighted by the auditor-general. “For an institution like the [Gauteng] Health Department to provide such misleading information undermines public confidence in it and compromises the lives of our citizens in this province,” More said. “It is unacceptable that while our healthcare facilities are under-resourced and struggling to meet the needs of the population, significant portions of the budget are being wasted or mismanaged.”

    Responding to More’s comments,  Modiba said that the department had spent 98.9% of its budget allocated for 2023/2024. He said that of the 1.1% (R1.1 billion) under expenditure,  R580 million has already been provisionally approved by Treasury to be carried over to the current fiscal year, subject to audited financial statements.

    “While the department aims to spend every allocated cent, achieving this goal is not always feasible due to various factors impacting the operational environment. For instance, some of the money was committed to purchase orders or invoices that could not be processed within the previous financial year leading to a rollover of funds. The amount covers grants for human resource training, national tertiary services, district health programmes and the national health insurance,” Modiba said.

    A ‘structural’ problem

    Professor Alex van den Heever, chair of social security systems administration and management Studies at Wits University’s School of Governance, said the health department’s leadership crisis at its core is a structural one.

    “South Africa has a huge pool of talent, and we are not short on good managers or people who understand health, and how to run a health service – but these are exactly the people the [Gauteng] department of health don’t want,” he said.

    “Why would they want a Babita Deokaran [an acting chief financial officer who was assassinated in August 2021 after flagging what appeared to be corruption at Tembisa Hospital] or someone who is actually going to root out the nonsense or someone who is going to properly manage patient care?” Van den Heever asked.

    Describing the department’s leadership as an “hourglass model”, Van den Heever said at the top are leaders with all the power, but little focus is on delivery. The pressure falls on an overstressed, underfunded middle management with limited decision-making power, which then trickles down as problems for those at the bottom.

    He added: “Hospitals can’t afford this kind of leadership, they fall apart. There is no strategy behind anything, so no maintenance, proper training and supervision of staff or clinical governance. Problems aren’t solved, they’re hidden.”

    Spotlight questioned the department’s alleged failure to attract “fit for purpose” candidates, resulting in more leadership and governance challenges for the department that filter down to hospital and clinic level.

    In response, Modiba stated that, for the first time since 2006, they have reviewed organisational structures, which have now been submitted to the Office of the Premier.

    “This is a major step towards ensuring that the Gauteng Department of Health has a structure fit for purpose that is geared to meet the service needs of the growing Gauteng population. Furthermore, a service provider has been appointed for the next three years to conduct ‘personnel suitability checks’. This will assist the department in its recruitment of suitably qualified employees who will be able to contribute meaningfully towards the achievement of the organisation’s strategic objectives,” he added.

    Offering a solution to fix some of the challenges crippling the health department, Van den Heever said that changing leadership structures to orient towards service delivery could mean better governance and management, improved staff motivation, renewed public confidence and ultimately better patient care. This, he said, would require the decentralisation of powers so that competent people can take charge in hospitals, make impactful decisions about appointments and budgets, and be accountable for pockets within a complex provincial health system.

    Republished from Spotlight under a Creative Commons licence.

    Read the original article.