Gauteng health MEC Brian Hlongwa may have used R1m of taxpayers' money to renovate his boardroom on the 22nd floor of the provincial head office, but getting to the top floor still requires using erratic lifts.
The effects of failing lifts at public hospitals can be dire. In August, a woman gave birth in a lift stuck between floors at Coronation Hospital (now Rahima Moosa Mother & Child Hospital). And a baby died after power went off at this 320-bed hospital. Also, there have been times when the hospital's ultrasound machines were not working.
At Chris Hani Baragwanath hospital, where the removal of CEO Arthur Manning drew criticism, it's not unusual for patients (including the critically ill and pregnant women), doctors and nurses to climb flights of stairs because of broken lifts.
Brian Hlongwa - It's a public works issue
This doesn't spur Hlongwa into action. "It's a public works issue," he tells the FM casually, from his lofty boardroom that overlooks ANC headquarters and crawling traffic on Sauer Street.
It's strange that Hlongwa isn't doing much about the broken lifts other than insisting that it's up to MEC Ignatius Jacobs's public works department, as if reliable lifts or power supply aren't essential to the delivery of quality health care. Jacobs's spokesman, Alfred Nhlapo, admits there is a problem and says his department is replacing 200 lifts between now and next July.
At R13,9bn, the provincial health budget is clearly insufficient, but who is sorting out the nonhealth factors that affect delivery? It seems hospital managers are either unable or unempowered (or intimidated) to deal with ill-disciplined staff, poor security and poor water supply, faulty lifts and generators, ageing infrastructure, theft of cutlery and linen and other nonhealth factors.
That leaves the problem with Hlongwa, but he's unfazed. "There's a difference between leadership and management. I'm a political head. My duties are to ensure the implementation of the strategy, not to run hospitals," says the man who doubles up as chairman of JSE-listed, loss-making Selco.
On Manning, who was "redeployed" last month after two years as Bara boss, Hlongwa sounds disappointed. This contrasts with how the Democratic Alliance and the Cosatu-affiliated Nehawu view the situation. They say his shafting was a bungle by head office. Tembisa and South Rand hospitals have also had their CEOs removed in this way.
"Managers must manage. We hire hospital CEOs for their operational expertise. You can't keep asking for more money. As CEO, be efficient and if you can't manage or operate efficiently, you should go."
Nehawu's Sizwe Pamla says Manning is paying the price for remaining independent and refusing "to be their puppet". In blasting Manning's removal, Pamla cites a report by Naledi, Cosatu's research arm. "It showed that Bara was one of the better-run hospitals, so why redeploy him? They want someone they can control - a puppet."
Says DA Gauteng leader Jack Bloom: "He's a scapegoat for government's failure, incompetence and under funding." Bloom says that though Bara gets a R1,1bn budget, it's barely enough to cover running costs.
In reply, Hlongwa argues that Manning got his priorities wrong. "How can you spend millions of a limited budget on phone bills and not buy baby cribs and other necessities? Prioritise, prioritise." But is this a logical way of looking at the problem? Having phones or ambulances that work is as important as drugs and equipment.
Hlongwa is himself still taking lessons on prioritising. Head office staff have more than doubled in less than five years and now an estimated R26m is being splurged on head-office building alterations, says his critic, Bloom, who blames this on mismanagement and patronage.
"There's too much duplication of duties, too much money paid to consultants," Bloom argues. Hlongwa says this is "nonsense".
"It's easy for the DA to criticise. We're using the consultants from the private sector. That's where the skills reside but they don't come cheap," he asserts.
Meanwhile, dispensary shelves lie bare at health-care centres at Orange Farm, in East Rand's Tembisa and even in Jo'burg, where shortages prevent operations from being done on time. A Soweto doctor in the public sector says government encourages nondelivery in that it rewards those who "cut costs". This in turn, he says, prevents doctors from carrying out their medical duties.
This should be food for thought for those in charge of the country's purse strings and the new health minister, Barbara Hogan.
Trade unions should also play their part and try to discourage theft and ill-discipline among their members. Yet Nehawu denies that some hospital workers misbehave or steal.
"Things are getting better. Soon we'll be able to compete with the best in the world," a then newish and zealous Hlongwa told the FM in 2006. Two years down the line, not much has changed.
This, says Hlongwa, is because his team, which includes consultants, had to lay a solid foundation after consulting with all staff "so that the left hand could talk to the right hand", and equipping facilities with hi-tech machinery and phone lines. "We realised that we needed to invest a lot in a strong foundation; that's what we have been doing."
The five-year turnaround plan - introduced in 2004 during former MEC Gwen Ramokgopa's tenure - included increasing the number of nurses. Here, the department is doing well, but it should prioritise other disciplines, too. Hlongwa is due to open another nurses' college this month. However, budgetary constraints, non health issues (an area he's refusing to touch), and a complex and bloated head office staff structure are likely to derail his grand plan to make life better for staff and patients.
Long queues - Still a problem
Long queues are still a problem, Hlongwa concedes, but is proud of his department's multipronged response. A few clinics, like densely populated Hillbrow and the West Rand's Bekkersdal, have been turned into 24-hour operations. He also recently launched a programme to deliver drugs to the homes of patients with chronic conditions.
To address under staffing, the department will hire paraprofessionals, a model that has apparently ameliorated shortages in Brazil, Iran and Mozambique.
