The Rural Health Advocacy Project welcomes the news that the Eastern Cape Department of Health is recruiting four doctors to work at the 120-bed Canzibe District Hospital in OR Tambo District, in the Eastern Cape. Three of the four doctors are expected to start by 1 July. This comes after months of advocacy by various parties and through various channels to see justice served for the people of Nyandeni Sub-District where Canzibe Hospital is located. The hospital is serving a population of 143 000 people in one of the most impoverished regions in the country (the former Transkei) and is currently left with only two fulltime doctors for day shifts. One of the two doctors is leaving at the end of this month. This plunges the hospital into a full-blown crisis with only one doctor left to serve the entire population until the new doctors have arrived.
Doctors are expected to see patients in the emergency and out-patients department; to do female, male, children, TB and other ward rounds; attend to mental health patients; attend to women in labour needing caesarean sections and do outreach to the feeder clinics. It is practically impossible for one or two doctors on their own to sustain quality healthcare services as per the norms and standards and to meet good clinical governance requirements. It is well known that staff shortages lead to burn-out, increase risks of medical errors, and lead to further resignations.
The hospital organogram accounts for nine doctors at this hospital. In February 2016, Canzibe Hospital still had seven doctors. Since then two community service doctors left at the end of their term; two resigned; and one transferred to another province. In June 2016 only two doctors were remaining.
While we welcome the anticipated arrival of three doctors on the 1st of July who will bring much needed relief, with the fourth doctor awaiting approval by the Premier, the question remains why did it take this long to recruit these doctors?
• The Rural Health Advocacy Project (RHAP) raised alarm with the Provincial Department of Health in October 2016 about the growing HRH crisis by letters, meetings, emails and phone calls. Despite promises and some attempts to transfer doctors from elsewhere in the province to Canzibe, in March 2017 the situation deteriorated further. An eager and suitably foreign qualified doctor who registered with the Health Professions Council of South Africa was the only candidate who applied for a medical officer vacancy at Canzibe advertised in November 2016 but no offer of employment was made and the reasons provided not given. The province tried to send doctors through an intra-provincial transfer, but none of the local doctors wanted to work at Canzibe.
• RHAP alerted the National Department of Health in November and again in May.
• The Hospital Board of Canzibe Hospital made several attempts over the past year to advocate for doctors and to bring other problems to the attention of the Department of Health, MEC and Members of Parliament.
• We are aware that the Hospital Manager also exercised her leadership by motivating several times over the past year to the District and Provincial Health Office for doctors to be appointed.
• The RHAP approached the Eastern Cape Health Crisis Coalition (ECHCAC) in March for support. RHAP is a member of the ECHCAC which is a collective of over 20 NGOs advocating for good health care for and with the people of the Eastern Cape. ECHCAC wrote to the ECDoH in March, and followed up several times. After the last correspondence, the ECDoH finally announced its plan to recruit and appoint 4 doctors.
This matter demonstrates a number issues:
1. Policies and strategies, promoting equity and access to healthcare, such as the national HRH plan, are not implemented as intended. Canzibe, and many other rural facilities that are out of sight and out of mind, are left to fend for their own;
2. We have a deep-seated problem with too many local doctors (including community service officers) refusing to work in rural areas where the staff shortages are the greatest.
3. As a result, in times of budget constraints, we risk filling the urban vacancies first where doctors do want to go, and slowly bleeding rural hospitals to death.
4. While the Department of Health tried to staff Canzibe though intra-provincial transfers, it could have acted faster to 1) advertise more posts and 2) recruit foreign qualified doctors when no local doctors could be appointed.
5. A concerted effort by a variety of stakeholders is required to put a spotlight on these cases of neglect and to demand a fair allocation of scarce resources based on need and not solely based on utilization rates. Communities lose trust when hospitals are severely understaffed and seek care elsewhere at great personal expense, or stop seeking care altogether. Utilization rates do not indicate community need. This is well documented in RHAP’s report: Cutting Human Resources for Health. Who Pays? An Eastern Cape case study.
6. At times of budget constraints, not all vacant posts may be filled. Critical health posts need to be defined and prioritized; and these include posts that are required to sustain a minimum level of care for vulnerable, impoverished communities that do not have access to alternative facilities at proximity.
We are aware that the MEC for Health in the Eastern Cape has planned a visit to Canzibe Hospital on 16 May. We welcome the MEC’s decision to investigate the situation, and wish to point out the following additional challenges at Canzibe hospital that require equal attention, over and beyond the doctors crisis.
• There are no therapists (occupational therapists; speech and hearing therapists, physiotherapists etc) at Canzibe hospital. Canzibe used to have a team of therapists prior to 2014. As a result, people including children with disabilities have no access to care and others spend exorbitant amounts of money, up to R600 round-trip, accessing health care at other hospitals in OR Tambo District. 9,6% of the population in Eastern Cape live with a disability and the % in rural areas is expected to be even higher;
• There is no dentist employed at this hospital, it goes without saying that the people of Nyandeni Sub-District need access to a dentist as much as any other region in the province and country;
• The hospital had two Clinical Associates, but both left and one has been replaced. Clinical Associates can greatly expand access to care while under supervision of doctors;
• Due to the staff shortage, doctors can no longer provide support visits to the 13 feeder clinics; which undermines the clinic/hospital relationship and leads to avoidable referrals at the expense of the patient.
• Emergency medical services take up to a day to assist patients in the community and the hospital for transfers.
• Hospital accommodation for staff is available but some of the accommodation is in a deplorable state. All staff regardless of category deserve a dignified place to stay.
The plight of ailing rural health facilities such as Canzibe, of which there are many across the country, can only be resolved if health care workers, hospital boards, clinic committees, and NGOs collaborate in joint advocacy for their right to access health care. To break the cycle of poverty and inequity, investment in rural areas must be a priority. As such we commend the Minister of Health’s plans to change the community service allocation system so that rural areas will finally be prioritized in the next round of community service allocations.
We will monitor and continue to report on developments at Canzibe Hospital in months to come. We also call upon the Eastern Cape Department of Health to put in place contingency plans urgently to bridge the month of June by allocating extra temporary doctors for the daytime shifts until the new doctors have arrived.
For more information, contact:
Ms Samantha Khan-Gillmore, Programme Manager Human Resources for Health, Rural Health Advocacy Project, cell: 083 378 8120