Are Provincial Health Departments Worth the Cost? Do we even need them?

In April 2018, the North West Department of Health misused R100 million allocated for HIV services by diverting it to purchase ambulances. The grant is specifically designated for combating HIV/AIDS. The companies hired for these services had questionable reputations and faced accusations of overcharging the government. Standard tender procedures were bypassed; instead, officials intervened to facilitate the deal.

This is just one of many cases where provinces have been described as acting rogue and unaccountable. Instances like these have cost tax payer billions of Rands due to corruption and maladministration. Furthermore, provincial health departments have been characterized as hotbeds of corruption, where patronage outweighs service delivery, resulting in significant suffering among the people.

Provinces' mishandling of healthcare worker employment prompted intervention from the Director-General of Health. Moreover, the Auditor General has cautioned that medico-legal claims and other expenses are depleting healthcare funds, posing a serious risk of financial collapse for provincial health departments.

The saddest part is that we may not even need provincial health departments. They represent another layer of bureaucracy that sucks money out of the fiscus with little to show for it. In fact, this issue was once discussed in detail in parliament by SCOPA Chairman, Mr. Themba Godi.

Mr Godi questioned the existence of a middle structure between the national and local government, and argued that there is not substantial reason for such a structure.

“There can and has never been a coherent and convincing conceptual argument about why between the national and local government there should be two other levels – provincial and district. They have proven themselves to be havens of corruption and inefficiency. They have an unnecessary drain on the fiscus, a bottleneck to service delivery and development. Nothing so far can mitigate for their continued existence, we therefore make a call to the House (NA) and the people of our country, that let’s find a common perspective that provinces and district municipalities be scrapped,” Mr Godi.

The elimination of provincial health departments and districts will free up billions of Rands, which can then be allocated to healthcare services and the hiring of healthcare workers. This viewpoint was endorsed by UDM's Bantu Holomisa, who argued that the introduction of provinces was a compromise to allay the fears of minority groups. However, this approach has proven ineffective and has become a channel for patronage dispersal. The health districts are even worse. They are described as mere buffer zones with no clear-cut service delivery objectives.

What we need is to establish a national health agency that reports directly to Parliament. This agency should possess full functional autonomy and sufficient resources to enhance our healthcare system. It should be staffed with experts in clinical care, finance, project management, procurement, human resources, and legal matters. Achieving this goal is more feasible than implementing fanciful the National Health Insurance.

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