By Youlendree Appasamy
Healthy Bugs sat down with Public Service Accountability Monitor’s health researcher, Thokozile Mtsolongo, to find out more about her and the organisation she works for.
The organisation (PSAM) is involved in the promotion of social accountability principles, as well as the greater framework of human rights and holding the state accountable to fulfilling these. The monitoring and advocacy focus of the PSAM aims to improve public service delivery and enhance the progressive realisation of constitutional rights. The PSAM evaluates budgeting, planning, expenditure and performance in the following service delivery departments of the Eastern Cape government: Education, Health, Local Government, Human Settlements and Economic Development and Environmental Affairs.
Thokozile Mtsolongo joined PSAM in 2011. Seeing as Mtsolongo is conducting research for her MSocSci degree on access to maternal healthcare services in rural Eastern Cape, she thought working at PSAM would suit both her research objectives and would be a sustainable job. “But over time, I came to understand the importance and relevance of the work being carried out by PSAM and other like-minded organisations, which I commend,” she said.
Mtsolongo didn’t set out from university with the goal of even being a health researcher, or involved with public health issues but her willingness to expand her knowledge to all fields of social research led her down this path. “My mind was open to expanding my knowledge in social science research. Coming out of university you always think that there is only one path to follow to developing a career. […]I have grown to love making linkages with information gathered, particularly working with numbers (government budgets) and translating those numbers into easy to understand information for the reader.”
In this interview with Thokozile Mtsolongo, health researcher at the Public Service Accountability Monitor (PSAM) explains some of the complexities of the EC Health Budget.
Q & A
- Why is there a recurring problem with underspending in the Eastern Cape province health budget when, according to various media reports and citizens themselves, quality healthcare isn’t being delivered?
“This has been known to be a historical problem within the department and has been going on for years in fact. There have been instances where has been called to answer for not being able to deliver on infrastructure it has planned to deliver on within a particular financial year. Reasons for when the Eastern Cape Department of Health (ECDoH) have not been able to deliver on infrastructural concerns range from supply chain management (SCM) issues within the department where correct procedures have been not being followed, including contracts that have not been carried out properly. In the 2012/2013 Annual Report, it was found that some of the infrastructure backlogs were as a result of strikes by the workers who were contracted to complete building of a hospital in the Eastern Cape. Such instances may not be directly linked to the performance of the Department, but a problem that a contractor needs to sort out with its staff.
The department needs to continue its work and when it fails we need to be asking questions, because at the end of the day that directly affects the people who seek those services in the mainly rural Eastern Cape.”
- How does HIV/AIDS expenditure fit into the Eastern Cape healthcare budget and how is Makana, as sub-district, benefitting from this?
The HIV/AIDS budget commitment as whole is delivered under two places, that is, the HIV/AIDS sub-programme (which sits under the District Health Services [DHS] programme), as well as the Comprehensive HIV/AIDS Conditional Grant. The DHS programme receives the largest allocation of the health budget. So we have what you call the HIV/AIDS Conditional Grant, which has tended to be the largest Conditional Grant allocated each year in all provinces. The use of the HIV/AIDS Conditional Grant is set at a national level, to fulfil national policies. Provincial HIV/AIDS needs and concerns, and the Department’s MEC sits in a position to determine what these needs are. The 2014/2015 Comprehensive HIV/AIDS Grant [the Conditional Grant] for the province is R 1 449 237 billion.
- Are our constitutionally enshrined rights being protected at the end of the day with the current expenditure on public health care in the Eastern Cape? And who can the public go to, to voice complaints about public healthcare?
When you’re talking about rights being protected, you’re forced to look at things from different perspectives. Certain sectors of society do feel like they are not being catered to as the Constitution requires, but there are others that hold the opposite opinion. Access to these rights is an important element to look at. There is always a need to interrogate what we mean by ‘access’ in the different contexts it occurs in. The availability and ‘option’ of private healthcare services in our society changes the conversation of ‘protected rights’. On a provincial level, the MEC of Health and Head of Department (HoD) are accountable to the citizens of this province for the public healthcare services in the Eastern Cape, so complaints should be delivered to them. PSAM is in partnership with Eastern Cape Health Crisis Action Coalition. This group was formed in 2013 with the sole purpose of driving forward the concerns of the people of the EC and the poor state of health care services in this province. We took our memorandum of complaints to the MEC for Health, Hon. Sicelo Gqobana as well as his HoD, Dr Thobekile Mbengashe.”
- From the 2014/15 mini-budget, can you see a rise in the Eastern Cape health budget allocations? Or, in other words, is our government ensuring better standards of social services?
Yes, there is a rise- in nominal terms. Last year’s budget was R16,584,328 billion, and this year’s budget is R17,549,012 billion. But where there is a rise it has to be looked at in context. What has been happening in the ECDoH is that the Department has tended to go over its budgets for a current financial year, and therefore taping into another financial year’s budget. The danger of this happening means is that the Department ends up using resources that are meant to take care of plans for the following year. A reduced budget in any way has to consider what impact it will have on services needing to be delivered.
- Do you feel any assurance for an improvement of the current service delivery crises being experienced in the Eastern Cape?
I tend to live in the hope that there will be improvements made and improvements have been made in a number of areas over the years. I always like to think that the Department is aware of the challenges it faces, and so will attend to those challenges. Prioritization is very key when it comes to addressing these challenges, but without losing sight of other responsibilities. There have been improvements in different areas, in different places. But, there still remains plenty of work to be done to improve health care delivery in this province.
- The Abuja Declaration of 2001 set a target for all African countries to allocate 15% of their National Budget to health-care, how much closer do you think we are to achieving that?
The health budget has received an allocation of R146 billion from the overall national budget in year 2014. That works out to be about 11% of the whole national budget (nominal rate) – obviously under the 15% mark. What the Abuja Declaration was trying to communicate in terms of that much expenditure is that ‘if nations spend 15% of their budgets on health, then their outcomes would follow a particular progression.’ What the country decides on in terms of its spending is a priority determined by that nation. Health and Education are the two top priorities in SA. In the Eastern Cape Province, health and education take the two top allocations in the provincial allocations. These demands on the national level are being realized through provinces, and so it’s when provinces are able to deliver on what they are mandated to do that, at the national level, we can then say we are improving as a nation.