Health officials ‘use public service rules to stifle dissent’
When personnel raise concerns, managers turn on them, says Campaign for Free Expression
Health officials are using loopholes in the rules that govern public sector employees to gag doctors and stop them drawing attention to the failings of state hospitals and clinics, a report from the nonprofit Campaign for Free Expression (CFE) finds.
Instead of acting on the concerns highlighted by health-care workers, managers are turning on them, and subjecting them to disciplinary action and intimidation, CFE SA project manager Hanifa Manda said on Thursday.
“Healthcare workers are censored. They are afraid to speak out because of a clause in the public service regulations that requires [them] to seek approval from a superior before engaging with the media,” she said at an event hosted by the CFE, the Progressive Health Forum and the Institute for Security Studies. The clause was not intended to stifle dissent, but is being abused by authorities to cover up their own wrongdoing, she said.
Fear of speaking out in the public health-care sector runs so deep that only a handful of the more than 7,000 public healthcare sector employees who were asked by the CFE to complete an anonymous online questionnaire had the confidence to do so, she said.
Manda speculated that potential survey respondents may have been particularly anxious about expressing their concerns because they were approached shortly after paediatrician Tim de Maayer was suspended for publishing an open letter about the problems at Rahima Moosa Mother and Child Hospital in Johannesburg.
Public health-care workers confront a host of challenges that compromise patient care, including medicine shortages, a lack of basic hygiene supplies such as soap and toilet paper, overcrowding, and inadequate medical equipment, but when they voice concerns they face sanction from their bosses, said Ebrahim Variava, head of internal medicine at Tshepong Hospital. Variava was suspended by the North West provincial health department in 2020 for flagging problems with the province’s preparedness for Covid-19. He was reinstated after his case attracted media attention and amid an outcry from fellow health-care professionals.
Many less senior health-care workers whose cases have not drawn public attention remain suspended, often for years, Manda said. CFE’s research identified at least 65 health-care workers who were placed on precautionary suspension in North West alone, she said, adding “Who knows how many more there might be?”
Suspensions are not only used to target health-care workers trying to improve service to their patients, but also to protect people who had transgressed, said governance expert Alex van den Heever, chair of social security systems administration and management studies at Wits.
“Many people are placed on precautionary suspension for a long time ... but there are no disciplinary consequences and they resurface in the system. It looks as though something is being done, but in fact [the issue] is just pushed off the radar and the people are redeployed in the system,” he said.
While front-line health-care workers should have greater freedom to highlight the failings they encounter in hospitals and clinics, it is also important to provide the public with audited information about the quality of these facilities, he said.
The Office of Health Standards Compliance, a statutory body charged with inspecting and accrediting public and private facilities, publishes only summaries of its findings, and should place the details of its inspections in the public domain, he said.
Health & Science Correspondent