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No Beth, Western Cape Health doesn't deserve its clean audit

I sent Dr Beth Engelbrecht, the head of the Western Cape Health Department (WCHD), Premier Alan Winde and Wendy Philander, DA chair of the WC Parliament Health Committee a report of my assessment of the WCHD's service. This followed an exchange of emails with Engelbrecht last week in which I told her about my experience at Abdurahman Community Health Clinic last month.

In my email I referred to Daily Maverick's uncritical interview of her about the department's first clean audit and her giving themselves top marks for performance managing a "burning platform" (see here). I contradicted their good news story with known problems about and my and users' poor assessment of facilities.

She replied, "Thank you for your mail. Please accept my unreserved apology for your negative experience of our services. We strive to be as best we can and what you have experienced is very unfortunate. I fully agree that a clean audit reflects good governance, yet the patient experience of our service is an even greater requirement. I am aware our services are under tremendous pressure and the increase in population juxtaposed against a reducing budget pose major challenges.

"We appreciate feedback to assist us in improving our services and I would like to invite you to share a moment to engage with the facility manager and perhaps jointly agree how we can collectively improve patient experience.

"Thanks again for taking the trouble to write to me. My best wishes accompany you."

I started writing a short response in which I took issue with her again, as in May, deflecting problems of poor service in the department to other things, here alleged declining budgets and increased patient numbers.

I suspected, though, it was a brush off. She compliments herself in the Daily Maverick interview but contradictorily says there are problems in the department, not with their management anyway, but matters out of her control. She doesn't need me to tell her what her facilities are like - doesn't she and her management ever visit them? Apparently not. As always, she was disingenuous and not to be trusted.

I then reviewed the department's financial reports going back the last five years. It confirmed what I knew that WCHD has adequate resources but is not managing them properly.  It is a large and complex department to run, but it all comes down to efficient and effective management which I believe is lacking to an extent.

Engelbrecht statements to me, WC Health Committee and public about "declining budgets over the last four years" and increased patient numbers were false. Why she said that I don't know. Either she and her senior management don't know how to read their own financial reports or she's and the WC Government are deliberately misleading and lying to the public. (On that score see here.)

The budget and actual expenditure has increased year-on-year and 45% since 2014. Employee costs at 58% of the department's actual expenditure, and increased 46% in five years, is and crowding out other necessary expenditure like capital which decreased from 5 to 4%.

Primary and admitted patient numbers have increased a small net 3.0%, which is also the increase of filled posts.

For 2018/19 health's budget at R23 billion (WCG quote R24bn) is 43% of the province's total budget, up from 36% in 2013/14.

In my opinion, WCHD doesn't deserve it's clean audit. The non-financial matters, particularly performance objectives, are problematic and that the auditor-general accepted at face value. If my assessment of the figures are correct and Engelbrecht made a misstatement to the committee and public, the auditor-general should be informed. This might constitute an "after the balance sheet event" that may impact on his findings.

See my full report here. Engelbrecht didn't respond despite inviting me to share my experiences with her and Abdurahman's facility manager. I knew it was a brush-off which was why I wrote it. I don't think she expected a response like this, though.

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