The national government does not have the skills or capacity to run Western Cape’s biggest hospitals from Pretoria, says the province’s head of health who adds that he believes he has a "moral" obligation to speak out against the plan.
Health Minister Aaron Motsoaledi’s intention to take control of SA’s 10 central hospitals has been debated behind the scenes for several years, but gained fresh impetus in the form of support from delegates at the African National Congress (ANC) conference in Mangaung last month.
The rationale appears to be partly linked to the national health department’s concerns about some provincial treasuries diverting funds intended for creating training posts for doctors, who are in short supply in SA.
But they also expose the fissures between the national government and the only provincial government controlled by an opposition party.
If the proposal is implemented, the Western Cape government would lose control of Groote Schuur Hospital and Tygerberg Hospital, which would be run from Pretoria.
"I have the greatest respect for the minister, and many of the proposals driven by him are very good … but how are you going to manage hospitals like these at a distance of thousands of kilometres?" Western Cape head of health Prof Craig Househam asked.
"I don’t believe the national health department has the skill or capacity to run these hospitals.
"I feel a strong, personal, almost moral need to speak out about this issue. I firmly believe this decision, in the current context, is a mistake."
Prof Househam — who has headed the Western Cape health department for the past decade and previously headed the Free State health department — said in an interview on Friday he believed that most of the justification for the proposal was the state of hospitals elsewhere in SA.
"Groote Schuur and Tygerberg are not perfect, but in the South African context they are well managed. Their CEOs are competent and well qualified, and (they) play a very important part in a health system focu sed at local level."
Dr Motsoaledi said that he was aware that the Democratic Alliance (DA)-controlled Western Cape was unhappy with his plans to take control of Tygerberg and Groote Schuur hospitals.
"But it’s been opposed to many things initially. It was vehemently opposed to National Health Insurance in the beginning, but has since then agreed to pilot it," he said. "It’s also opposed the Office of Health Standards Compliance.
"It’s opposed to training doctors in Cuba, which is an indictment — there are poor kids in Khayelitsha and Mitchells Plain (who would benefit from the programme).
"The problem with the Western Cape is they regard themselves as a different country, because they are under the DA."
The DA last month warned Dr Motsoaledi to "leave alone things that are not broken". The party’s health spokeswoman Patricia Kopane said he was playing politics and should rather focus on hospitals where the ANC governed "because that’s where the problems are".
Prof Househam said the Western Cape had raised its concerns about the proposals to take over the administration of the hospitals, which were discussed at the National Health Council in September 2011. He had also expressed his views directly to Dr Motsoaledi, he said.
The proposals would fragment the national health system, disrupt the referral procedures in Western Cape and blur the lines of accountability, Dr Motsoaledi had been told.
Prof Househam said Dr Motsoaledi’s argument — that centralising control of the hospitals would deal with the problem of provincial treasuries diverting funds intended for training posts for doctors — did not apply to the Western Cape.
"Money has been diverted, but not in the Western Cape. In fact, we have added funds from the equitable share. Clearly, if we had more money we’d fill more registrar posts," he said.
Dr Motsoaledi said the proposal for centralising control of the teaching hospitals had been driven by academics at the universities attached to them. They were concerned about the limited capacity of their institutions to train doctors and specialists.
Training could not be left to the "whim of the provinces", Dr Motsoaledi said, arguing that national control would ensure there were sufficient training positions and equipment.
There would be scope for central hospitals to run some of their own affairs, he said.
"We’ll give them the powers as they demonstrate the ability to handle them. For example, they would be able to procure some equipment and hire certain categories of staff, such as cleaners," he said.