Poor decisions hurting patients
This week’s open letter from healthcare professionals appealing to finance minister Enoch Godongwana to reverse the budget cuts to health is a well-timed reminder that it is always society’s poorest and most vulnerable citizens who pay the price for the government’s bad decisions.
Senior clinicians from Cape Town’s top public hospitals, supported by more than a thousand signatories, set out in cold detail the harm done to patients as the Western Cape health department has been forced to implement a hiring freeze in response to the budget crisis. When there isn’t enough money to fill posts for doctors and nurses as they leave or retire, or bridge the gap with agency staff, the consequences are far-reaching. Surgeries are cancelled or delayed. Waiting times for routine appointments grow. The cuts also compromise the system’s capacity to train the next generation of specialists and stretch the remaining staff to breaking point.
Their letter comes hard on the heels of health minister Joe Phaahla’s frank admission that the government doesn’t have enough money to employ all the doctors it needs to meet patient needs. Young doctors who recently completed community service are no longer assured of a government post and must instead look to the private sector for employment, while the numbers of patients who depend on the public health service are served by fewer clinicians, increasing the risk of medical negligence.
The reasons for the budget crunch are no secret. Last year’s higher-than-anticipated wage settlement between the government and public service unions was reached after the Treasury had finalised the February budget, leaving it with a R37.4bn gap to fill in an environment of falling tax revenue and rising debt service costs. The November medium-term budget policy statement thus saw the Treasury make unprecedented in-year cuts to the expenditure budget of R21bn, with another R120bn cut planned for the next two years. Provincial health departments have been left scrambling to find the money to honour the wage deal, which was only partially funded by the Treasury, and confront cuts to their conditional grants.
While staff in provinces may not be speaking out publicly, there is no question that the scenario sketched by clinicians in the Western Cape is playing out across the country.
Citizens are paying the price for the government’s decision to cave into union demands and agree to a 7.5% wage increase instead of the 1.6% planned on by the Treasury for 2023/24, along with its continued failure to stamp out corruption and appoint senior leaders based on merit rather than political allegiance.
The Treasury is now putting the final touches to the budget, which Godongwana is due to table in parliament on February 21. The macroeconomic environment is still dire, and there is of course a new budget challenge thrown up by the cabinet’s illconsidered decision to approve a new loan scheme for students without having first established a sustainable financing mechanism to support it. Nevertheless the Treasury would do well to remember that no nation can thrive without healthy citizens.