A survey by health activists found one in four facilities reported a shortage of key HIV or TB medicines in the three months prior to the survey. Picture: SUNDAY TIMES
A survey by health activists found one in four facilities reported a shortage of key HIV or TB medicines in the three months prior to the survey. Picture: SUNDAY TIMES

THE national Department of Health intends taking over South Africa’s 10 biggest hospitals — including the world-renowned Groote Schuur in Cape Town — as some provincial governments lack capacity to manage them, says Health Minister Aaron Motsoaledi.

The funding and administration of hospitals is a provincial responsibility, but in some provinces — including Gauteng, Eastern Cape and Limpopo — the public health system has virtually collapsed and hospitals struggle to provide basic levels of care.

Dr Motsoaledi said that 10 hospitals earmarked for administration by his department were "national assets" that had suffered under provincial governments.

Most of them were teaching hospitals, but the training of young doctors was "jeopardised" whenever a provincial health department faced collapse.

"If the province collapses — like the Eastern Cape is about to — these hospitals suffer," he said.

However, the hospitals earmarked for national administration include some of the best-run in the country, particularly Groote Schuur Hospital and Tygerberg Hospital in the Western Cape.

Gauteng has four hospitals earmarked for national administration: Steve Biko, George Mukhari, Charlotte Maxeke and Chris Hani Baragwanath.

Universitas Hospital in the Free State, Nelson Mandela Academic Hospital in the Eastern Cape and KwaZulu-Natal’s King Edward VIII Hospital and Inkosi Albert Luthuli Central Hospital will also be run from Pretoria.

The decision to remove responsibility from provincial governments was taken at the African National Congress (ANC) conference in Mangaung earlier this month.

Democratic Alliance health spokeswoman Patricia Kopane said on Thursday that Dr Motsoaledi should "leave alone things that are not broken".

She said she was shocked at the intention to include Groote Schuur Hospital and Tygerberg Hospital, as there was "no crisis in the Western Cape".

It was the only province that had obtained a clean audit for the past three years, which showed that it was capable of running an administration "very well", Ms Kopane said.

"I think the minister is just playing politics — he must focus on where the ANC governs because that’s where the problems are."

The Gauteng health department was plagued by power failures and neglect to pay suppliers, while a lack of service delivery in the Eastern Cape and a lack of doctors and equipment in Limpopo meant those provinces faced "serious problems" that required them to be placed under national administration, Ms Kopane said.

In an interview following the ANC conference, where he was a key player in the party’s health policy discussions, Dr Motsoaledi said delegates also pushed for the establishment of a pricing commission  to regulate the "extremely exorbitant fees" charged in private healthcare.

He said the commission would be established through legislation, making it a statutory body.

"The prices being levied are exorbitant by any standards," the minister said.

Regulating them would effectively balance the landscape, as the other side of private healthcare — medical schemes — were heavily regulated.

Dr Motsoaledi said that health service providers were currently free to charge whatever prices they wanted, which was sometimes way out of reach of even the well-to-do middle classes.

"They just close their eyes and do what they want. It’s the law of the jungle," he said.

A standard abdominal procedure could cost up to R1m, he said, which often bled medical aids dry — resulting in both the schemes and their members suffering.

"I want this commission. I want it to be statutory, it must come and regulate.

"Private hospitals are supposed to be assets for the people of South Africa. They can’t be priced out of reach," Dr Motsoaledi said.

The pricing commission will aim to ensure that when the National Health Insurance (NHI) system is in full force, it will not be affected by high hospital fees.

Dr Motsoaledi said he wanted the commission up and running within the next two years, if it was not delayed by legal challenges aimed at "suffocating" it.

The NHI system is being piloted in 10 districts around the country. The system will be implemented gradually in phases over 14 years.

 The ANC conference resolved to examine other measures to manage health costs, including awareness programmes intended to promote healthy lifestyles.

A national health commission, expected to be chaired by  President Jacob Zuma, will be established to promote healthy ways of living. Dr Motsoaledi said the conference had emboldened him to continue his healthy lifestyle drive, which included tightening restrictions on alcohol advertising and reinforcing anti-tobacco legislation.

The health commission would oversee initiatives to reduce alcohol and tobacco use, and encourage healthy diets free of fatty foods, the minister said.