Page 173 - Provincial Treasury Estimates.pdf

Estimates of the Provincial Revenue and Expenditure (EPRE) – 2023/24 Financial Year
Medico legal claims

The department has in the past and still continues to sustain high financial losses due to the scourge of
Medico-legal Cases. Medico-legal claims account for the highest numbers of current contingent liability
thereby making it the highest risk area.

Eastern Region (OR Tambo and Alfred Nzo Districts) has the highest litigation cases in the Province due
to various reasons, which amongst other includes maternity related challenges, orthopaedic and other
clinical challenges. These are also exacerbated by poor staffing, inadequate skills, other social
determinants of health, e.g. poor road infrastructure thus affecting response by the EMS teams in certain

areas, employment status, access to health care. Funds that are utilised in the payment of these claims
deprive the Department of its ability to procure necessary materials, commodities and equipment’s, and

other clinical essential that contribute to the delivery of quality healthcare in the Province.

Whilst the department is faced with these challenges, it needs to be mentioned that, poor records is

another challenge, which affects not only smooth running and accountability for operations, but affects the
quality of defence when cases are presented in court. This challenge is also due to poor staffing at records

management units and lack of focus on patient records management as a function separate from patient
administration. The Department has made several appointments in the 2022/23 financial year to
strengthen rehabilitation services, including critical operational and management posts at the three

identified Rehabilitation Centres of Excellence at Nelson Mandela Academic Central Hospital (NMACH),
Cecilia Makiwane and Frere Hospital academic complex; and Dora Nginza Hospital.

Impact of load shedding on health facilities

Since Eskom has escalated load-shading to stage 6, more facilities are under strain to ensure continuity
of healthcare services and mitigate any potential clinical risks to both patients and staff. The department

had to dig deep into the already strained finances in order to provide electricity power supply-essentially
through back-up generators. The higher the stage of load-shedding, the greater the dependence on
generators for electrical supply, which leads to greater cost.

The increase in load-shedding also affects sensitive medical machinery and equipment. With suppliers of

generators and medical equipment generally located outside of the provinces, and parts often sourced
from overseas, there has been delays in repairs and this has affected the continuity of service delivery.
Contingency measures the department introduced include transferring patients out of facilities, diverting

patients requiring emergency care to other facilities, and increasing the patient loads at those already
strained facilities.

Another challenge, especially at stage 6, is interruption in water supply. There are hospitals that receive

water supply through electrical pumps from rivers in rural areas. When water supply is affected during high
stages of load-shedding, the department had to arrange water to the affected facilities and install water

tanks to supplement the system. The department also had to dig boreholes and, in some instances, install
water purification systems so that the water from the bore-hole can be utilised.

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