The Impact of COVID-19 on South African Healthcare
Michael Gooding
As of August 13th, South Africa has experienced 572 000 total COVID-19 infections and 11 000 deaths across its nine provinces, according to official statistics released by the Department of Health. Though Gauteng is currently faring the worst, the Eastern Cape has a particularly high proportion of deaths to recoveries. It was and is one of the provinces hardest-hit by COVID-19, and its public hospitals provide ample example of how pandemics such as this one can rapidly overwhelm underprepared institutions and dramatically worsen existing systemic flaws.
Official summary of the status of COVID-19. South Africa - National Department of Health
In an interview with BBC, Dr. John Black, an Infectious Diseases Physician at Livingstone Hospital in Port Elizabeth, revealed that the hospital had lost 30% of an already-minimal staff and confirmed reports of patients fighting over limited oxygen supplies in one of its wards. The critical lack of personnel and resources such as ambulances, respirators and personal protective equipment created dangerous and inefficient working conditions. An anonymous doctor interviewed alongside Dr. Black reported doctors “portering, scrubbing the floors, working with one or two remaining nursing staff” and a separate report by the Daily Maverick (a South African newspaper) details the discovery of blood-colored water discovered leaking from drains during a safety audit of Livingstone Hospital. Though the Department of Health claimed this to be a consequence of improperly disposed beetroot peels, the building refuse and discarded PPE could not be excused.
The conditions faced by medical practitioners in Livingstone and other hospitals has led to immense amounts of fear, stress and exhaustion, a fact acknowledged by Dr. Thobile Mbengashe, secretary general of the Eastern Cape Health Department. He further admits to “a number of very critical structural issues that are really affecting our response”. Cole Cameron, secretary and CEO of the Igazi Foundation (a haematology advocacy group in South Africa) claims that current failures in South African health services are a consequence of “historic issues of staff-shortages, labor problems, lack of leadership and, sadly, corruption, cronyism, and fiscal mismanagement” that have been severely affecting it for the last 10 years and can be traced back to the consequences of racial segregation in the country’s Apartheid era.
Rats drink blood-colored water at Livingstone Hospital - The Daily Maverick
Many hospital employees such as cleaning staff, laundry workers, porters and nurses are unhappy with the conditions they face. Khaya Xaba, a spokesman for the National Education, Health and Allied Workers Union (NEHAWU) agreed to an interview and elaborated on these concerns. He states: “we have had to fight a lot with government for the protection of members”, citing intermittent supply of personal protective equipment (PPE) and noncompliance with the Occupational Health and Safety Act and WHO regulations. Following legal action by NEHAWU, government agreed to a discussion on the 8th of April to discuss the resolution of these issues, but Xaba has yet to see any positive change on their part. The union is currently preparing to take further action, and has prepared a bulletin regarding their findings and goals during the pandemic.
The National and Eastern Cape Health Departments have made efforts of debatable effectiveness to alleviate overcrowding and resource shortages in hospitals. The German car manufacturer Volkswagen partnered with the Eastern Cape government to facilitate the construction of a new field clinic in Port Elizabeth. However, towards the end of June, Dr. Sibongile Zungu, head of the Eastern Cape Health Department’s project management team, admitted that the province would need to send patients to its neighbors; KwaZulu-Natal, the Western Cape and the Free State. Her team identified shortages in equipment, transportation and staff that would render local field hospitals ineffective.
South Africa has an unusual private healthcare structure, in which private hospitals host medical specialists such as radiologists, therapists or lab technicians, but do not directly employ them. According to the Bhekisisa Centre for Health Journalism, provincial governments aimed to secure service level agreements with private hospitals and healthcare practitioners in order to make up for predicted bed shortages in every province (Data backed up by an official report prepared for the South African COVID-19 Modelling Consortium). However, this is complicated by the fact that each medical specialist is independent and must be contracted separately from the hospitals in which they work.
Private practitioners are also suffering the impact of COVID-19. Private general practitioner Nkateko Munisi reports that the South African Medical and Dental Association, a network of around 2000 practitioners to which he belongs, has been receiving only half as much business on average, due to patients lacking income and fearing infection. Private sector paediatrician Simon Strachan corroborates this report, stating that his own practice only receives 70-80% of the business it normally would and conveying fears that he may lose his practice as a result. The Progressive Health Forum, a national advocacy network drawn from the health sector and civil society, released a proposal for addressing the risk to private practitioners through support payments based on their 2019 income.
South Africa has, like much of the world, been severely impacted by the COVID-19 pandemic, with serious consequences for both public and private healthcare. Though the pandemic has created many new problems, the systemic flaws it has worsened are the greater issue. Understanding the origin and context of these flaws is a step towards addressing them and learning how to respond to future disasters of a similar scope.
Michael Gooding is an incoming second-year student, majoring in biomedical engineering. He is hoping to focus on accessibility of new medical technologies.
