The Gauteng health department has racked up R25bn in irregular expenditure over the past three years, while underspending on its budget by more than R6.4bn in the same period.
This has left some state hospitals in the province unable to afford taps and toilet paper in bathrooms.
The state of hospitals in Gauteng hit the headlines this week after a patient at Helen Joseph Hospital, Tim London, posted a video showing dirty, dilapidated facilities and complaining about how rude and unprofessional staff were towards patients.
Irregular expenditure now stands at R2.7bn in the 2023/24 financial year — up by R400m from R2.3bn in 2022/23, according to the department's past three annual reports.
In the 2021/22 financial year, the department had irregular expenditure of a whopping R22bn which included R2.3bn a month on the extension of security contracts that did not go through tender processes.
The department underspent by R1.1bn in the past financial year, R2.7bn in 2022/23 and R2.5bn in 2021/22.
The department told the Sunday Times that the Treasury had “provisionally approved” the unspent R1.1bn in the past financial year to be carried over into the current financial year.
Spokesperson Motalatale Modiba said it was not always possible to spend every cent allocated to the department.
“Achieving this goal is not always feasible due to various factors. For instance, some of the money is committed to purchase orders or invoices that could not be processed within the previous financial year, leading to a rollover of funds.”
Modiba said those amounts would cover grants for human resource training, national tertiary services, district health programmes and the national health insurance (NHI).
A programme with an allocated R154m budget for remedial work for fire and occupational compliance at Charlotte Maxeke Hospital in Parktown, which was planned for the past financial year, was not undertaken, according to the department's annual report.
Another planned maintenance project at Helen Joseph Hospital, for which R29.6m had been set aside during the 2022/23 adjustment budget last year, was also not undertaken.
Health receives the province's second-biggest budget, after education. The department was allocated R64.8bn in the 2024/25 financial year, up from last year's R60bn, making it the department with the biggest increase in budget.
The education budget stands at R65.8bn, up R2bn from the past financial year.
Modiba said the department had a campaign to address staff attitudes while also implementing an infrastructure refurbishment programme in a bid to improve public healthcare in the province.
“In an effort to improve the patients' experience of care, the department on November 17 2023 unveiled a provincewide intervention called the 'I serve with a Smile' campaign, that seeks to address staff attitude, bolster morale among healthcare workers to improve patient experience and reduce patient dissatisfaction and complaints.”
Modiba said the department was projecting “to overspend within the compensation of employees” due to the 7.5% public sector salary increases which were not fully covered through allocated budgets for the current financial year.
“However, the amount [to be overspent] has not yet been fully determined.”
The department's salary bill has risen by about R300m in the past three years from R59.6bn in 2021/22 to R62.5bn in 2023/24, according to Modiba.
Modiba said the department spent R695m on fighting litigation in court, which is the most in the past three years, with R507m spent in 2022/23 and R369m in 2021/2022.
Wits adjunct professor Alex van den Heever said the Gauteng health department suffered from “institutionalised corruption at the highest levels”.
“This is evidenced by the extraordinary levels of irregular expenditure — that is repeated year after year. The accounting officers [heads of departments] are never held properly to account for these massive, and arguably wilful, infringements,” Van den Heever said.
He said the failure of the department “to address the rampant theft of resources that [whistle-blower] Babita Deokaran identified, suggests that the department and the province have leadership problems”.
“Importantly, despite massive evidence of wrongdoing, the former CFO, who Deokaran reported to, was permitted to resign three years after Deokaran's murder, with no action taken by the department.”
DA health spokesperson in Gauteng Jack Bloom said the consistent underspending showed chronic poor financial management.
“How can it be that available budget is not spent to help treat patients? Last year, R250m set aside to cut the backlog for radiation cancer treatment was unspent — this has cost the lives of many patients,” he said.
The heads of departments are never held properly to account for these massive, and arguably wilful, infringements.
— Wits adjunct professor Alex van den Heever
Bloom said if premier Panyaza Lesufi was “serious about fixing Gauteng health he needs to replace Mr Lesiba Malotana as head of department”.
“We need competent and honest hospital CEOs, instead of the cadre deployments that cause so much trouble,” Bloom said.
Human rights and social activist Mark Heywood said there was “no intention by the authorities to fix the crisis in Gauteng health”.
“The health department has a budget of R65bn in the current year and is served by three universities, with some of the best health professionals and health systems experts in the country. We’re a province with a developed, sophisticated private sector with all its specialists willing to assist in a geographically small province that should be relatively easy to co-ordinate and manage as far as health promotion, disease prevention and treatment are concerned.”
He said the reason for the system's collapse was “maladministration and corruption and the lack of political will to replace the implicated officials at the top”, and there was no strategy to rescue or revive the situation. — Additional reporting by Gill Gifford
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