The recent spate of loadshedding has caused further division between the public and private health sectors. Health Minister Joe Phaahla bluntly stated that the public sector has been prioritised for exemption from loadshedding, as it serves the majority of the population, and the private healthcare sector âtakes care of its own facilitiesâ. Given Phaahlaâs admission, one cannot help but notice the irony that it is this sector, a self-sufficient anomaly in South Africa, that the proposed NHI Bill will dissolve. However, as set out in this article by Chris Bateman, even private healthcare institutions are ultimately at the mercy of Eskom: âdespite having adequate back-up systems, these systems have not been designed to cope with the extended hours of the current outagesâ. This article first appeared on MedBrief Africa. â Nadya Swart
Private hospitals ânot prioritised âfor loadshedding exemption: Minister
While 37 state hospitals have now officially been exempted from further loadshedding with plans to extend it to a total of 300, it seems as if private health institutions will have to tackle the ongoing crisis on their own. This is despite being subjected to many of the same challenges public facilities are facing as the extended rolling blackouts continue.
Briefing the media on Friday, Health Minister Joe Phaahla stressed that the public sector has been prioritised for exemption because it is providing healthcare services to between 85% and 90% of the population.
âAs 85% to 90% of the public depend on public health services, that is where our main focus is. As the Ministry of Health, we do have a responsibility for the entire health service, but we know that the private sector does take care of its own facilities. Therefore, we did not prioritise private hospitals in our call for exemption as they only service between 10% to 15% of the population and they have their own authorities, who have the responsibility to negotiate on their behalf,â the Minister noted.
âNo requests for assistance received from private sectorâ
Phaahla added that no requests from the private sector to assist have been received but that his department âwill encourage electricity authorities to include the private sector in their exemptions as we interact with themâ.
In the past weeks, there have been several calls from role players in the private sector, including the Hospital Association of SA (HASA), that all hospitals should be exempt as patient care in both sectors is adversely affected.
HASA stressed that in some areas access to care at multiple private institutions has been eroded because they are being loadshedded simultaneously; that there is a large-scale degeneration of sensitive equipment; and that, despite having adequate back-up systems, these systems have not been designed to cope with the extended hours of the current outages. In addition, operation costs are rising exponentially due to increasing generator-, diesel-, storage â and security costs.
Reacting to the Ministerâs announcement, Dr Caroline Corbett, president of the South African Society of Anaesthesiologists, said there was at least some positive intervention to alleviate the impact of the blackouts on healthcare facilities, though this had come only after significant cost already to both patients, infrastructure, and practitioners.
She expressed disappointment that Chris Hani Baragwanath Hospital was not exempted given the enormous population it services.
Dr Corbett added that there was a need for government to offer transparency into how and why certain facilities were exempt and not others, in view of the matrix alluded to in the briefing.
Avoidable crisis
âMy feeling is that we have to take the positives where there are positives. At least government listened and acknowledged the voices of healthcare workers and activists who have lobbied for exemption. It is, however, vital that we continue to hold government accountable for delivery as has been promised now, both on the short-term exemptions as well as the long-term sustainable solutions, as no specific timelines have been provided for either,â Dr Corbett said.
She added that it was disappointing that health workers must continue to fight so hard for patient-centric care and the defence of the national health asset.
âThat should be the job of our leadership and ministers and a collaborative effort of all government. This is an avoidable crisis and the risk to the health sector should and could have been identified and mitigated before it happened. We need proper proactive responses, not this constant waiting for a crisis to occur before action is taken, and under public duress.â
Referring to the ministerâs comments about the private sector not requesting assistance, Dr Corbett said she was aware of facilities that have applied for exemption.
âPerhaps there is a chain of command or communication breakdown, but I know that there were certain groups that applied. I think the issue here is that there is a disconnect between national government and local and provincial governments when it comes to messaging and narratives.
âMost importantly, we must stop dividing the health sector into private and state facilities and seeing certain population groups as more important than others â whether itâs taxpayers, whether itâs demographic groups or whether itâs provincial groups. We are all South Africans, and we must make sure that no patient gets left behind. For the countryâs morale and the communityâs sense of social justice, you cannot say one group is more important or more vulnerable than another because we all have equal constitutional rights.
âWe are all South Africans, and everybody needs to see the government functioning and advocating for its citizens. We are not seeing that at the moment. We are seeing disaster management and crisis responses over and over and over again, where we should be seeing leadership and governance and insightful strategic planning with the focus on equitable health access to quality care,â Dr Corbett concluded.
In his presentation, the minister acknowledged the calls by healthcare workers and organisations to have healthcare facilities exempted from loadshedding.
He said although the majority of public health facilities have back-up power supply systems, including generators and uninterrupted power supply (UPS), these alternative sources of energy were not designed to provide back-up electricity for extended periods of time. Some of these generators are old, while others have no necessary capacity to power the entire facility.
âGenerators have been proven not to adequately meet the increasing demands during loadshedding in health facilities, leaving some hospitals with no choice but to switch off some critical areas, compromising patient care,â Phaahla said.
Asked about deaths as a direct result of loadshedding, the department said no reports have been received so far. It, however, acknowledged that it is having a major impact on elective surgeries and that the backlog in the public sector now stands at between 170,000 and 180,000.
Phaahla said a multifaceted strategy is being developed for immediate, short- and long-term implementation of exemption and measures that will keep the lights on.
Provincial departments have been urged to consolidate lists of facilities for submission in the follow-up meeting next week with Eskom, instead of individual facilities making requests. These will assist the teams to determine the costs for additional resources for network reconfiguration.
The criteria for exemption include patient volumes, the nature of specialised services hospitals provide and the technological and medical equipment they have.
The department is further engaging National Treasury to discuss the additional budget implications to sustain the loadshedding contingency plans, including unbudgeted increases in diesel and oil expenditure to run the generators and maintenance costs.
Plans are also afoot for phased investment in renewable energy through solar power installation at health facilities as part of an energy mix pending the outcome of a feasibility study.
Solarised energy will be prioritised for areas such as theatres, intensive care units, and high-tech and advanced equipment.
âLoadshedding compels us that in future when we construct new facilities, we must revise our plans and costs to include new sources of energy over and above generators. In addition, we must ensure the installation of the dedicated feeder line to avoid the current exercise of reconfiguring the electricity networks,â the Minister concluded.
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