Mpumalanga’s health is failing –
Poor management and leadership instability lead to R2-billion in irregular expenditure
The Mpumalanga department of health incurred nearly R2-billion in irregular expenditure in the 2014-2015 financial year — making up more than 80% of the province’s total irregular expenditure, according to the auditor general’s report.
The report, released in November, reveals that the department failed to investigate the irregular expenditure identified in the 2013-2014 financial year.
The department “has [also] been struggling to address a qualification on assets for the past five years, even though consultants are appointed every year to assist”.
A breakdown in the department’s controls “led to basic errors, such as assets owned by the department not being recorded in the books and assets being recorded in the books without proof of physical existence”, according to the report.
The department has not been able to improve “audit outcomes due to instability in the leadership and the slow response by management to address concerns regarding the quality of the submitted financial and performance information”.
Health activists believe this situation has contributed significantly to “the deteriorating quality” of the Mpumalanga health department’s service delivery and the consequent bad health indicators.
The province has the highest diarrhoea (5.3%) and pneumonia (5.2%) case fatality rates in the country and the severe acute malnutrition case fatality rate was extremely high at 19.1%, according to the 2014-2015 District Health Barometer of the Health Systems Trust. Only 12.4% of grade one pupils in Mpumalanga had access to school health services in 2014-2015, as opposed to 23.2% nationally.
The 2012 National Antenatal Sentinel HIV prevalence survey recorded a 40% HIV prevalence rate among pregnant women in the province’s Gert Sibande district; this is significantly higher than the national average of 29.5%.
A Bhekisisa investigation in Gert Sibande district has revealed that many people live more than 30km away from public health clinics. In some cases the facilities are so far away that residents are left with only one option: private healthcare, because those services are much closer to where they live than public health services. But most of these people cannot afford to pay for private healthcare (see “It’s only 32km to the state clinic but, for the poor, it’s a world away”).
Mpumalanga health has had more than five heads of department and chief financial officers, both acting and appointed, over a period of two years. Most did not last for more than six months.
The auditor-general’s report also stated that two deputy director general positions were vacant at the end of the 2014-2015 financial year. The report warned that the health department “might not be able to meet [its] service delivery targets for the following year (2015-2016)” because of cash shortfalls.
The department’s annual report noted that nearly R1-million was used to pay the salaries of 19 health department officials who had been placed on precautionary suspension between April 2014 and March 2015. These employees comprised about half the total number of suspended officials across 12 departments in the Mpumalanga government.
But Mpumalanga health spokesperson Dumisani Malamule has refuted claims of a crisis in the department, saying instead that the department is “doing well in terms of service delivery”.
In a response to questions posed by Bhekisisa, Malamule said the province has taken drastic measures to address issues such as drug and staff shortages in public clinics and hospitals. These measures include increasing the number of medical students to study in Cuba, and a partnership with KwaZulu-Natal to train nurses to work in Mpumalanga.
Malamule said, contrary to the