Life Esidimeni scandal raises questions about public-private partnerships

These partnerships will be critical if National Health Insurance is implemented

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Photo of Qedani Mahlangu
Former Gauteng MEC for Health Qedani Mahlangu resigned following the release of the report of the Health Ombud which implicated her department in the deaths of at least 94 mentally ill patients. Photo from government website

After the deaths of 94 mentally ill patients and counting, who were moved from Life Esidimeni care to NGOs, President Zuma in his State of the Nation address said all recommendations made by the Health Ombud will be implemented.

More power will now effectively reside with the National Health Minister Dr Aaron Motsoaledi rather than with the provincial heads of health.

Health MECs in all provinces will have less ability to construct, conclude or dissolve Public Private Partnerships without the Minister of Health having a major say.

This might have stopped some of the problems that arose when the former MEC, Qedani Mahlangu, decided to end the arrangement between Life Healthcare and the Gauteng province, despite strong warnings not to do so from many experts and doctors.

The ending of the Esidimeni contract took place when former MEC Mahlangu decided the province should not spend the amount of money on the contract – over R300 per day per patient. Moving patients into community care would reduce the cost to a little over R110 per patient per day.

Following the deaths, patients that have been relocated to places such as Sterkfontein psychiatric hospital, are costing between R1,000 and R2,000 per person per day.

Gauteng’s newly appointed Health MEC Gwen Ramokgopa, in her previous tenure as MEC, also cancelled an arrangement with Life Healthcare in 2003 for cost reasons, which was at the time delivering acute care to Baragwanath Hospital patients many of whom had AIDS. 

Somewhere at the bottom of the loss of life to 94 psychiatric patients, a pubic private partnership (PPP) lies in tatters.

PPPs will be crucial to the functioning of the National Health Insurance when and if it gets off the ground. It will require resources far beyond those of the National Department of Health (NDoH) and the provinces.

The South African health care arena is full of PPPs, which greatly vary in their construction and in their successes and failures. The NDoH needs the capacity of the provinces and then may still lack the skills to deal with such things as the financing, negotiations and monitoring of contracts with the private sector. National Health Insurance plans for some arrangements, such as between clinics and the state, have already, apparently, been shelved.

Muddying the waters, there are several types of PPPs – some formal, some informal, some set up through the Department of Finance, which has a section dedicated to such entities.

A source close to finance said NGOs already in bad odour with government would likely be cast as the villains of the 94 deaths. But there had been no proper monitoring of the NGOs and probably little monitoring of the contracting too.

However, he felt that the report by Health Ombudsman Professor Makgoba had “given a huge boost” to the Office of Health Care Standards, which was not able to do its work while operating under heavy-handed censorship.

GroundUp attempted to reach the Minister of Health on the day before the State of the Nation Address and has not yet had a reply.

GroundUp also tried to talk to one of the large hospital groups, Netcare, which is known to be in favour of PPPs, but it declined to comment.

TOPICS:  Health

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