Section 27 of the Constitution provides that everyone has the right to have access to healthcare services and no one may be refused emergency medical treatment. The state, according to this provision, “must take reasonable legislative and other measures within its available resources to achieve the progressive realization” of this right – with a strong emphasis on realisation. In addition, section 195 of the Constitution requires public administration (which includes those public service departments and public servants responsible for health care) to:
- promote and maintain a “high standard professional ethics”;
- promote the use of resources in an “efficient, economic and effective” manner;
- provide services “impartially, fairly and equitably and without bias”;
- respond to the people’s “needs”;
- remain “accountable”;
- be “transparent” and provide the public with “timely, accessible and accurate information”;
- cultivate “good human-resource management and career-development practices, to maximise human potential”; and
- ensure that public administration is “broadly representative of the South African people, with employment and personnel management practices based on ability, objectivity, fairness, and the need to redress the imbalances of the past to achieve broad representation”.
In 2008, the South African Human Rights Commission (SAHRC) completed an intensive nation-wide investigation into healthcare services in South Africa. It found a “wide range of systemic, nation-wide shortcomings in the public healthcare system and recommended to the national Department of Health, amongst others, that government must:
a. Conduct skills audits of senior management and implement appropriate interventions such as training and awareness campaigns to capacitate senior staff;
b. Install appropriate infrastructure for the public health care system to function optimally; and
c. Provide funding to public health facilities, particularly in rural areas of the country.”
In December 2013, in a report on the state of hospitals in Mpumalanga (in which several hospitals were found to be in a critical state resulting in the violation of the right to access healthcare services), the SAHRC stated that the government had failed to respond proactively to its recommendations contained in the 2008-report.
The SAHRC recently completed hearings on the state of public health services in the Eastern Cape (of which the findings will feed into national hearings scheduled for later this year to investigate South Africans’ access to the right to health) and judging from the testimonies heard by the SAHRC, the Eastern Cape should not be expecting a pat on the back.
In addition, in 2013 the National Healthcare Facilities Baseline Audit was published and found that in 3 880 public health facilities audited in South Africa, compliance with vital measures in six priority areas required for “patient-centred care” averaged around 48%. These six priority areas were identified as positive and caring attitudes (30%), waiting times (68%), cleanliness (50%), patient safety and security (34%), infection prevention and control (50%) and availability of medicines and supplies (54%). The Audit also identified the state of physical infrastructure has having a “major impact on the functioning of services and client satisfaction” and indicated that “facility infrastructure management needs to be improved, especially at [primary health care] level… Prioritised attention should be given to those facilities without provision of water and electricity at the time of the audit.”
In recent weeks, public healthcare facilities and services, in particular in the Free State, Eastern Cape and KwaZulu-Natal again made news headlines for all the wrong reasons. The inability of national and provincial governments to manage public health care in terms of the constitutional values and principles as required by section 195 of the Constitution seems to be at the heart of the problem. The result is a violation of the right to access healthcare, the right to dignity and, sadly, also the right to life. Unfortunately, unless national and provincial governments are willing to face these facts and fix public health care facilities and services now, these gross human rights violations will persist. You can bet your life on it.
By Adv Johan Kruger, Director: Centre for Constitutional Rights