The Department of Health is scrambling to avoid a stand-off with nurses who have threatened to work in their own clothes if a dispute over the provision of uniforms is not resolved.
Since 2005, nurses had received an annual allowance to buy their uniforms. But this ended on 31 March this year, after a new agreement was signed in the Public Health and Social Development Sectoral Bargaining Council in terms of which they would get uniforms instead.
As a result, nurses did not get the usual allowance in April – R2600 a year, according to Spokesperson for the Democratic Nursing Association of SA (DENOSA) Sibongiseni Delihlazo.
Instead, they were supposed to be provided with uniforms by 1 October 2023. The agreement stated that in the first year, government must provide nurses with four sets of uniforms, one pair of shoes, and one jersey. In the second year, government must provide three sets of uniforms, one belt, and one jacket.
The plan was that the procurement process would be centralised. But at another bargaining council meeting, in June 2023, the health department said it would be difficult to provide the uniforms on time.
Then on 12 July, Sandile Buthelezi, director-general for the DOH, issued a circular to all provincial health departments notifying them that the uniforms would be provided from January 2024 to January 2025.
The circular stated that the DOH would use a decentralised approach to providing uniforms by using provincial tenders.
“Provincial heads are responsible for participating and facilitating in tender processes through the bid specification in terms of colour, fabric composition and garment, development, review of the policy and monitoring and evaluation,” Buthelezi wrote.
Until January 2026, the circular said, nurses would be expected to wear the new uniform from Monday to Thursday and wear their old uniform from Friday to Sunday. From January 2026, when they would have both years’ issue, nurses would be expected to wear the new uniforms every day.
DENOSA responded to this a week later, and said the department’s circular went against the bargaining agreement.
Delihlazo said they proposed that if the department is unable to supply the uniform by 1 October, they must pay nurses an allowance as previously.
If the department failed to provide uniforms or pay an allowance, DENOSA said, its 84 000 members would embark on an indefinite protest action by wearing their own clothes to work from 1 October.
Delihlazo said the yearly allowance did not cover the cost of a full uniform. “Their uniforms are tearing and the colour is fading. So how can you expect nurses to wear uniforms if you don’t pay them a uniform allowance?”
He said the tender process meant the colour of the nurses’ uniforms and the quality of the fabrics might differ from one province to the next. The process also “opens a window of opportunity for corruption,” Delihlazo said. “Money may be given for uniforms but the tender process is porous.”.
Then, at a last-minute meeting of the bargaining council last Thursday, the department proposed to put on hold the supply of uniforms until 2024, according to a DENOSA statement. Meanwhile the health department would pay nurses an allowance of R3,153 by 30 November.
DENOSA said the agreement should be signed by the end of the week. If not, the union said, nurses would work in their own clothes.
The health department did not respond to GroundUp’s questions.
The Law Society of South Africa (LSSA) has urged members of the public and civic associations to formally object to proposed amendments to the Road Accident Fund Act which, if approved, will have “dire consequences” for all South African road users.
The draft amendment bill was gazetted earlier this month by the transport minister. It proposes major changes to how the fund operates and how it will pay claims.
According to the LSSA, it proposes significant changes to the existing law, including removing the rights of drivers, passengers and pedestrians to claim compensation for injuries they have suffered. Instead, it proposes that the fund will only provide significantly reduced “social benefits”.
And, says the LSSA, an innocent injured party would still be denied the common law claim against the guilty party for the balance of his or her loss.
Yet all road users contribute directly or indirectly to the fund through the fuel levy, estimated to be about R45-billion a year.
“The poor and disempowered, who make up the vast majority of claimants and who are compelled to use public transport, will bear the brunt of the consequences of these amendments. They will be forced into the public health system, as the prescribed tariffs will not cover the actual costs incurred at a private hospital. Under the present system, many receive treatment at dedicated private healthcare facilities,” the LSSA says in its statement.
Claimants will also not receive any lump sum payments and, if they are not able to produce a payslip, it was unlikely that they would receive compensation for loss of earnings.
The LSSA said those who can afford it will be compelled to take out private accident cover for medical and other expenses as well as accident benefits.
“This is likely to be very costly, as there will be no reimbursement of expenses covered from the fund. Medical aids will more than likely exclude cover or the cost thereof will have to materially increase to preserve the funds in the pool for all members.”
The LSSA said road accident victims will be uniquely discriminated against by the proposed legislation.
“Their rights to be compensated for harm suffered by the fault of another will be taken away. Persons who suffer harm from medical negligence or are injured in train or plane or boat accidents or in shopping centres, hotels, construction sites, holiday resorts, private homes or by electrocution or pollution and by a host of other causes, have unfettered rights to seek compensation from the person or entity who caused them harm.
“Innocent motor vehicle accident victims, alone, do not have this right, despite the fact that they pay premiums to the fund.”
At present, injuries sustained in a motor car accident anywhere in South Africa by any person are covered by the Fund.
The Bill now excludes injuries suffered in motor vehicle accidents in parking areas, sports fields, farm roads, driveways, private estates, game reserves or any other private road.
People who are not citizens or permanent residents are also not covered.
Persons crossing a highway are not covered. Persons injured in a hit and run are not covered. Pedestrians, drivers and cyclist who may test over the legal limit for alcohol and their dependents are not covered.
The Bill also proposes doing away with payments for pain and suffering, loss of amenities of life, disability, disfigurement or shock.
It also does away with lump sum payments for loss of earnings or support, replacing them with monthly payments, and giving the fund the right to continually reassess its liability to continue to pay.
While at present all medical and other expenses reasonably incurred that arise directly from the accident are covered, these will now be subject to a prescribed tariff. Any future medical expenses have to be pre-authorised.
The LSSA said the Bill also largely ousts the role of the courts in determining contested claims, establishing instead alternative dispute resolution procedures followed by referral to be a yet-to-be established Road Accident Fund Adjudicator.
Co-chair of the KZN Personal Injury Lawyers Association Anthony De Sousa said the biggest issues around the Bill was what was not known, such as what “social benefits” were and what the treatment tariffs would be.
“We don’t know what we are signing up for”.
“What also worries me is the people it excludes, such as pedestrians crossing highways. They don’t do that for fun. They do it because they have no choice and are trying to get to work or home.
“They are poor people and if they are knocked down, they really need help. To exclude them is just weird.”
He said while there may be a case not to cover motorists who don’t have licences, or who are over the legal alcohol limit, the Bill also proposed that their dependents are not covered, such as a child who is injured.
“The kids are not at fault, but suddenly they have no claim.”
He said the approach seemed to be: “Let’s try and save some money”.
“We pay a lot of money to the fund in terms of the levy. If you were to take that money and take up an insurance policy, you would probably get better cover and better value for money.
“I don’t think, no matter how they change it, it won’t work until they sort out the dysfunctionality, the administrative inefficiencies in the fund. You can change it to whatever system. They cannot properly administer it and run it.
“If they did their jobs properly, the fund would be saving itself a bucket load of money.”
De Sousa said the association was presently putting together its formal response to the proposals.
Collen Msibi, spokesperson for the Department of Transport said, “The bill is out for comments. The department will welcome all views and suggestions for its consideration.”
Reporting of gun crime in South Africa is wildly inaccurate, work by the South African Medical Research Council (SAMRC) suggests. This is because the official death notification form does not distinguish between gun deaths from accidents and gun deaths from homicide.
The SAMRC has called on the government to update the country’s official death notification form. In a September 2023 South African Medical Journal (SAMJ) editorial, researchers and scientists Pam Groenewald, Richard Matzopoulos, Estevão Afonso and Debbie Bradshaw, say the form does not comply with international standards. While the World Health Organisation recommends reporting manner of death on the medical certificate for cause of death, South Africa’s form does not allow this, they say.
As a result, South Africa does not have accurate information on injury statistics, says Groenewald, a specialist scientist at SAMRC.
“Given that South Africa has got a really high injury burden, this is really not acceptable,” she said.
The SAMRC has pointed out that accurate, timely mortality data for natural and non-natural deaths is especially important after the Covid pandemic.
In a press release, the SAMRC said natural deaths had spiked during Covid waves, while injuries had fallen during government-imposed lockdowns and alcohol sales bans. “Of particular concern is the significant impact of alcohol bans on injury-related deaths,” the council said.
The release also said the statistics are necessary to develop and monitor programs to reduce injuries and violence, and track Sustainable Development Goals of road traffic injury reduction, gender equality and reducing violence-related death rates.
South Africa’s official mortality statistics overestimate accidental injuries and underestimate homicides, transport and suicide deaths, according to a research report also published in the September 2023 SAMJ.
In official death notification form data from Stats SA for 2017, nearly 99% of firearm deaths were classified as accidental and only 1% as homicide. But the SAMRC’s National Cause-of-Death Validation Project (NCoDV) found more than 88% of firearm deaths were homicide, and its Injury Mortality Survey (IMS) found more than 93%.
Similar differences occurred for suicides. Only 0.3% of firearm deaths were recorded as suicide in the 2017 Stats SA data, but they were recorded as 7% in NCoDV and IMS data.
The research report says NCoDV and IMS provide more detailed and consistent data on causes of injury than the death notification form, but they are costly and time-consuming, and not feasible for routine surveillance.
“It costs a lot of money, when we could be getting this data in with every death certificate that gets completed,” Groenewald says.
She says the SAMRC has been asking for an updated death certificate form since 2012.
No annual mortality report since 2018
Also, Stats SA has not published an updated mortality report since the pandemic. The last official report was released in 2021 for the year 2018.
“We’ve got no cause-of-death data at all, not just injuries, nothing. We haven’t seen a death certificate from during the Covid period; we don’t know what doctors have reported,” she said. “It’s mind boggling.”
Felicia Sithole, deputy director of media relations for Stats SA, said in a statement that the Mortality and Causes of Death report had been delayed by a backlog of processing death notification forms as a result of the Covid lockdown, and because of Census 2022 work.
Sithole said Stats SA is committed to publishing the 2019 and 2020 Mortality and Causes of Death reports by the end of March 2024.
“Stats SA fully comprehends the importance of the Mortality and Causes of Death release, especially during the Covid-19 pandemic, and acknowledges that our data must conform to international standards,” she said.
The SAMRC report also calls for the dormant National Forensic Pathology Services Committee to be reactivated. This would help improve data quality, the report says. The committee, established in 2014, has been inactive since 2018/9.
Foster Mohale, a media officer for the Department of Health, said the Minister of Health is in the process of appointing a new National Forensic Pathology Services Committee.
The Department of Home Affairs had not responded to requests for comment at the time of publication.
Photo by Miguel Á. Padriñán: https://www.pexels.com/photo/syringe-and-pills-on-blue-background-3936368/
The South African Pharmacy Council (SAPC) has been given judicial go-ahead to introduce its Pharmacy-Initiated Management of Antiretroviral Treatment (PIMART) initiative, which will allow specially trained pharmacists to manage and prescribe medicine to patients with HIV and tuberculosis.
Pretoria High Court Judge Elmarie van der Schyff has dismissed an application brought by a doctors’ organisation – the IPA Foundation – for the setting aside of the programme.
She said the pilot project had emphasised the value of the initiative, which was in line with the World Health Organisation’s vision to promote widely accessible primary health care.
“The untapped value of pharmacists in fighting HIV was also emphasised by the efficient role pharmacies played in meeting health care needs and providing health care services during the Covid-19 pandemic,” she said.
“The need to widen access to first line ART and TPT therapy on a community level is not a figment of SAPC’s imagination but a dire need that is also evinced in other countries.”
The IPA Foundation approached the court, under the Promotion of Administrative Justice Act (PAJA), seeking to review and set aside the SAPC’s decision to implement PIMART.
IPA claimed that the SAPC had failed to give interested parties an adequate opportunity to comment before the initiative was implemented. It further contended that PIMART unjustifiably encroached on the domain of medical practitioners and was in conflict with legislation.
IPA also accused SAPC of misleading the Director-General of Health, claiming there had been extensive consultation with stakeholders, which led to the approval and issuing of permits for the initiative.
The SAPC said the application should be dismissed. It said pharmacy-provided primary healthcare was a well known and functional concept in South Africa and PIMART was simply a “widening of this”.
Referring to the background and context, Judge van der Schyff said, in line with WHO recommendations that all people living with HIV must be provided with ART, the department of health had requested the SAPC to consider and implement interventions that would ensure that patients had increased access to medicines.
This led to the SAPC requesting the Director-General in August 2018 to consider issuing permits to pharmacists who had completed supplementary training, to manage patients and to dispense medication under PIMART.
In March 2021, the SAPC published a notice for public comment regarding the adoption of PIMART. The first permits were issued in August that year.
However, IPA submitted objections outside of the timeline for comments. It said this was because its members were struggling with another wave of the Covid-19 pandemic.
“Pharmacists and doctors operate in distinct and separate professional domains, the boundaries of which are closely guarded and some tension exists … IPA’s objection to PIMART seems to be rooted, partially at least, in this professional tension.
“This is evidenced by its fear that the decision to implement PIMART might ‘open the floodgates’ and ‘pave the way for pharmacists to ultimately treat and prescribe other schedule 4 drugs in respect of acute illnesses’,” the Judge said.
She noted, however, that the National Drugs Policy, in line with WHO guidelines, promoted “task shifting” to advance access to medicine and that at primary level, prescribing should be competency based, not occupation based.
Any alleged adverse effect that PIMART held for a medical practitioner had to be considered against the need to expand primary health care services aimed at preventing and treating HIV and providing first-line ART therapy.
Judge van der Schyff said the initiative gave members of the public a choice as to whether they wanted to approach a pharmacist, who had been issued with a permit, or a general practitioner.
In considering procedural fairness, the judge said there was nothing sinister in the timing of the notice calling for comment, that the project was not something hidden in secrecy and “I find it improbable, as alleged, that none of IPA’s members had timeous knowledge of the board notice”.
The decision to implement PIMART also fell within the ambit of the SAPC’s powers.
Evidence also showed that the PIMART training course was developed to ensure that pharmacists who successfully completed the training would be suitably qualified to safely and effectively assist in providing ART.
Judge van der Schyff dismissed the review application and ordered IPA to pay the costs.
Professor Francois Venter, former President of the Southern African HIV Clinicians Society and Director of Ezintsha, an HIV research organisation at Wits University, commented, “I hope this is the end of it. The pharmacies are an essential part of the health system, and pharmacists internationally play a big role in expanding HIV services.”
The hepatitis B virus is estimated to cause about 820 000 deaths a year globally. It is one of the leading causes of liver cancer. One in 20 people in South Africa is infected with hepatitis B, yet few people know about or have been tested for the virus.
During a media briefing on Friday, organised by the Gastroenterology and Hepatology Association of Sub-Saharan Africa (GHASSA), a panel of experts stressed the need for urgent interventions to eliminate hepatitis.
There are clear solutions, the experts said: increase awareness, increase access to testing, and prevent childhood transmission through birth-dose vaccination and screening and treating pregnant women.
“We are way overdue on bringing hepatitis out of the shadows and into the light,” said Professor Mark Sonderup, from the University of Cape Town’s (UCT) academic hospital at Groote Schuur.
In South Africa, an estimated 2.8 million people have chronic hepatitis B. Liver cancer caused by hepatitis B is on the increase in Africa and worldwide. Besides cancer, the virus can cause serious liver disease.
Hepatitis B is transmitted through bodily fluids, including semen and blood. Antiretroviral treatment for chronic hepatitis B is available but only 22% of cases are diagnosed.
An estimated 76 000 children in South Africa under the age of five have hepatitis B. Children infected with hepatitis B are more likely to develop a chronic infection.
Children infect each other: the virus multiplies in the body without presenting symptoms and a drop of blood shared through play between children can transfer the virus.
“They walk around like ticking timebombs, spreading infections,” said Dr Neliswa Gogela, liver disease specialist at Groote Schuur. Hepatitis B is 100 times more infectious than HIV, said Gogela.
Children born in South Africa receive a hepatitis B vaccine at six, ten, and 14 weeks old. If a vaccine dose was given at birth, it would cut out the first six weeks during which a child could become infected. Birth-dose vaccines are government policy but it has not yet been implemented. Other African countries like Namibia have introduced birth-dose vaccines.
The virus can also be transmitted from mother to child during and after birth. Pregnant women should be screened as part of prenatal and antenatal healthcare services, said Professor Wendy Spearman, head of Hepatology at UCT. Those eligible for treatment should receive antiretrovirals to prevent transmission of the virus to the child.
Hepatitis B is a silent killer, said Professor Mashiko Sechedi, head of gastroenterology at Groote Schuur. The virus stays in the body and only presents symptoms when the disease is at an advanced stage. It can cause multifocal liver cancer which renders the liver inoperable. “In South Africa, we’re seeing young patients presenting with advanced disease,” said Sechedi.
Professor Eduard Jonas, a surgeon at Groote Schuur, said that half of the patients in Sub-Saharan Africa who are diagnosed with liver cancer die within two and a half months of diagnosis. Late diagnosis and lack of treatment capacity make liver cancer particularly deadly in Southern Africa, he said.
Screening and testing for hepatitis are not easily accessible, said Professor Geoff Dusheiko, from Kings College in London. Whereas anyone wanting to do an HIV test can go to any government clinic and receive a point-of-care rapid test, they cannot do so for hepatitis B.
Rapid tests for hepatitis B are available but have not been rolled out by the government, so the only way to do a hepatitis test through public health facilities is to take blood, which is sent to a laboratory for testing.
While HIV, malaria and TB have attracted significant attention and funding, hepatitis has not. “We need people living with hepatitis B demanding access to treatment,” said Spearman.
Staff, including nurses, at RK Khan Hospital in Chatsworth, Durban, picketed on Wednesday over poor working conditions at the facility. Photo: Tsoanelo Sefoloko
Nurses, administration staff and general workers brought parts of RK Khan Hospital in Chatsworth, Durban, to a standstill for about an hour on Wednesday. They protested outside the hospital to highlight what they say are poor working conditions.
Protesting nurses say they are forced to perform cleaning duties in addition to patient care because the hospital has not employed enough cleaners. Other workers complained of staff shortages in the administration and general units.
Workers say they met with the management in February. Union leaders had asked the facility to commit to resolving their complaints.
Nurse Zizakele Ndlovu said they were told by the union leaders that working conditions would improve. But nothing changed, she said.
“The conditions we work under at the hospital are not good. We end up having to work more hours, and we don’t get paid for overtime. Sometimes I even work as a clerk,” she said.
“The department treats us as if we don’t know our job, and we don’t deserve what we are asking for. We lost many workers to Covid; some retired and others resigned. Those vacancies have not been filled. Even at top management there are lots of vacancies and this leads to poor service.”
Chairperson at the hospital of the National Education, Health and Allied and Workers’ Union (NEHAWU) David Mpongose said they had engaged management and had been promised that the situation would improve.
“Our bosses are arrogant. They really don’t take us seriously. Each time they make empty promises, so we decided to protest for the provincial government to assist us,” said Mpongose.
Xolani Mnguni, a cleaner, said he earned R7800 per month under the hospital’s previous contractor, but now only earns R3000 under the current contractor. He also said he has to do jobs other than cleaning.
Hospital CEO Linda Sobekwa accepted the workers’ memorandum and signed it on behalf of the provincial health department. She promised to ensure that the department responded within ten days as requested.
Agiza Hlongwane, spokesperson for the KwaZulu-Natal Department of Health, said officials would consider the workers’ demands and respond to them.
By Vincent Lali, Chris Gilili, Liezl Human, Tariro Washinyira, Nombulelo Damba-Hendrik, Thamsanqa Mbovane, and Mkhuseli Sizani
“You have shown the power of the people by closing all the hospitals,” National Education Health and Allied Workers’ Union (NEHAWU) Western Cape provincial secretary Baxolise Mali told striking union members on Wednesday. “The employer says people are dying. It is not our responsibility to keep people’s lives.”
Mali was speaking to strikers outside the Khayelitsha District Hospital in Cape Town, as NEHAWU members continued a wage strike which has disrupted hospitals and government offices across the country. The government considers the wage negotiations for 2022 to be settled but NEHAWU and several other unions are still demanding up to 12%.
Police presence outside the hospital had kept protesters away, said hospital CEO David Binza. He said the situation was “better than yesterday”, when “things were bad”.
Binza said services at the hospital had been severely affected by the strike on Monday.
Protesters had prevented people coming in and out of the hospital. Staff had ended up working 24 hours because there were not enough nurses to relieve them, and there was a shortage of nurses in childbirth wards. “Yesterday they prevented night staff from gaining access into the facility. It was mostly doctors that they allowed in. Doctors alone can’t work properly,” he said.
Today things had been better, he said, as the police had arrived early and kept protesters away from the hospital.
Western Cape health spokesperson Mark van der Heever said shift changes at the hospital were being closely monitored after patients in critical condition had to be transferred to other hospitals such as Helderberg, Tygerberg, Mitchells Plain and Karl Bremer.
Striking workers outside Khayelitsha District Hospital on Wednesday. Photo: Vincent Lali
“On Tuesday night, 7 March, protesters disrupted services and blocked staff from entering Khayelitsha District Hospital until 11pm. The ongoing disruption has directly resulted in staff shortages as they are prevented from entering, backlogs building up and other operational challenges.”
He said protests had been reported at Karl Bremer and Tygerberg hospitals, but services had not been disrupted.
Mali said NEHAWU’s intention was to “collapse the provision of government services” to force the government to the negotiating table. “Our tactics involve closing workplaces, to force workers to get out and switch off their computers.”
Home Affairs offices in Khayelitsha were closed. Disappointed, Luthando Tiso said he has been going to Khayelitsha Home Affairs to collect his ID since Monday. “I can’t get a job without an ID,” he said.
In the city centre, the Home Affairs office in Barrack Street and the offices of the Department of Labour were closed and there was a strong police presence.
One man said he had been to the Mitchells Plain Labour Department offices on Monday and Tuesday only to find them closed because of the strike, and had come to Cape Town hoping for help. “I desperately need to claim from the Unemployment Insurance Fund. I lost my job in January. My rent and children’s school fees are already behind,” he said.
Eastern Cape
In the Eastern Cape, Department of Health spokesperson Yonela Dekeda said hospitals were being run by skeleton staff.
“We had an incident early in the morning where striking workers blocked the Cecilia Makiwane Hospital’s entrance in East London. But police were called to remove them.”
Dekeda said unions which were not supporting the strike action had raised concerns that their members were being intimidated and denied access to workplaces.
“We do appreciate responsible shop stewards who have called their members to order, where necessary, and ensured that critical services continue and that our patients receive necessary care,” she said. “However, we take very seriously those employees who intimidate others, and cause services to be affected negatively.
“Appropriate action will be taken in all such instances, and law enforcement agencies are being deployed.”
At Laetitia Bam Day Hospital in KwaNobuhle, Kariega, Eastern Cape deputy secretary of NEHAWU, Busiswa Stokwe told about 100 striking workers: “We know we will be attacked even in the community, accused of not caring for patients. But the same community when you are doing the work of ten people, whilst you are four, would insult you, saying you are lazy. We must put ourselves first.”
A patient who did not want to give his name said he had arrived at 5am to have three teeth removed but had been ordered out by striking workers at 7am. “They came by car and on foot and sang in the corridors. We realized that we should go back home, with aching teeth.”
“We were about ten and have no money to remove teeth at a private doctor, who charges R350 per tooth,” he said.
Gauteng
In Tshwane, striking workers closed down the offices of the Department of Public Service and Administration, shouting and insulting some workers who were inside the offices.
There was a stand-off between the striking workers and police, as the workers closed off Hamilton and Edmond Streets with huge stones and turned cars away. Police moved the workers away.
Phumuzo Malahleni, a registry clerk at the Department of Agriculture, said his R12,000-a-month salary was too low to cope with the soaring cost of living. “As public servants we can’t afford anything. Violence and going to the streets is the only language our government understands.”
NEHAWU Gauteng provincial chairperson Mzikayise Tshontshi told GroundUp that the battle for a wage increase was far from over.
He said NEHAWU had been called to the Public Sector Bargaining Council on Thursday. “Our negotiators will be there, but the rest of us will continue shutting down public services.
“We believe our strike has been resoundingly successful. From Monday to today, the numbers have been growing. Tomorrow we want to intensify the strike,” said Tshontshi.
Addressing the crowd outside the department, Tshontshi called out those who were still at work.
“We are also aware of ‘amagundwane’ (rats). Some are sitting in cosy offices, and then when we win this battle they are going to be first in the queue because they think they deserve what we have fought for. There have always been traitors in every struggle; this is no different.”
At Tembisa hospital, striking workers blocked the entrance with burning tyres and debris while chanting slogans. Calm was later restored.
Free State
Free State health spokesperson Mondli Mvambi said the province had obtained an interdict on Wednesday morning to prevent strikers from disrupting services at hospitals and clinics. “The order does not stop the strike but stops acts of intimidation, violence, disruptions and instigating.”
Mvambi said hospitals hardest hit were National District Hospital, Universitas, Pelonomi and Medical Depot in Bloemfontein. “There were no nurses at work and patient care was seriously compromised.” Mvambi said calm had been restored but services remained strained as nurses were still not at work.
“At Manapo in QwaQwa they are not allowing nurses into the hospital. At Boitumelo in Kroonstad, picketers were singing at the gate but services are said to be continuing. At Pelonomi Hospital, nurses in ICU were forced out by the strikers.”
North West
In the North West, services at least six hospitals were disrupted by the strike: Klerksdorp-Tshepong, Potchefstroom, Taung District, Moses Kotane, Ganyesa District, and Gelukspan. There were pickets outside several other clinics and hospitals.
Mpumalanga
In Mpumalanga, spokesperson Christopher Nobela said that all health facilities had been affected and hospitals were working with skeleton staff in hospitals.
Limpopo
Limpopo health spokesperson Neil Shikwambana said, “We do not have reports of disruptions in any of our facilities so far.”
KwaZulu-Natal
Workers stopped work at Inkosi Albert Luthuli Central Hospital in Durban for several hours on Wednesday morning, singing outside the hospital. Patients were allowed to enter.
NEHAWU branch secretary Sikhumbuzo Gumbi said workers decided to go back to work at midday so they could assist patients. “As workers we decided to protest in the morning then attend to patients around lunchtime.”
Gumbi said the staff would continue protesting in the mornings until the strike ends.
Prince Mthalane, Durban NEHAWU regional secretary, said clinics had been closed in KwaMashu and at Polyclinic workers had burned tyres. Police had been called but workers had talked to them and no-one had been arrested.
“The aim is to have a peaceful strike,” he said.
GroundUp was unable to reach the health department spokespersons in KwaZulu-Natal or the Northern Cape.
Police
“Innocent patients have been caught in the crossfire and inconvenienced by something which has nothing to do with them,” said Department of Health national spokesperson Foster Mohale. He said the Minister of Health had asked the Minister of Police to strengthen the police presence in areas affected by the strike.
“Skeleton staff has also been available to give care to patients who could not be discharged,” said Mohale.
South African Police Union spokesperson Lesiba Thobakgale said the union had joined NEHAWU in the protest. “As SAPU, from today we have served a strike notice and we are joining the other unions,” said Thobakgale.
Striking members of the National Education, Health and Allied Workers Union (NEHAWU) blocked the department of Home Affairs offices in Cape Town on Tuesday. Photo: Thomas Kachere
Patients were turned away from some hospitals as members of the National Education, Health and Allied Workers Union (NEHAWU) and other unions pressed forward with their wage strike, in spite of a court interdict.
Many government offices were closed for several hours.
NEHAWU has approached the Labour Appeal Court to appeal against a decision to enforce the interdict against the strike granted by the Labour Court to the Department of Public Service and Administration.
In Cape Town, police intervened after a scuffle broke out after a member of the public who was queuing for service at the Department of Home Affairs office in Cape Town called protesters names.
The police warned the protesters not to engage in any violence.
Provincial General Secretary of NEHAWU, Baxolise Mali said, “Today we have escalated matters”. He said hospitals including Khayelitsha Day Hospital and Somerset Hospital had closed, and the offices of Home Affairs and Labour were closed. “SASSA offices will close soon for social grants,” he said.
NEHAWU served the department with a notice to strike on 24 February after wage negotiations deadlocked. The department offered a 4.7% increase while unions demanded between 10% and 12%.
Ronald Ruiters had queued at the Home Affairs office in Cape Town for hours for a temporary ID, without getting help, he said. “Yesterday I was here at 4:30am. I am an old man. What about people who are suffering now including sick people in hospitals? There should be a better way of dealing with these issues.”
“Since morning the police were here but they could not control the protesters, nothing is working here.”
Mali said workers were angry at a statement by acting Public Service Minister Thulas Nxesi who had described the strike as reckless.
“The acting minister called people reckless and said they need to go back to work … go back to work on what basis? Come with an offer: we are willing to negotiate.”
“It is reckless for the government to impose salaries on people. It is reckless for the government to expect the people who have been praised during the time of Covid for having to work hard in very difficult conditions to serve our people to get peanuts.”
“The ‘no work no pay’ principle is not a new thing. Let them deduct the money, we are used to poverty. “
Mali said members of the public did not understand. “They stand in long queues because the government is refusing to employ more people to work for Home Affairs, [Department of] Labour and SASSA. Instead they increase the cabinet. Too many deputy ministers and what work do they have to do?”
“What needs to be done is to create employment so that people get served quickly. That is all we are fighting for. We are not going to compromise.”
In Pretoria, striking workers occupied the Department of Labour Head office, singing and shouting at workers inside to come out. They also closed entrances to the offices of the Department of Higher Education and Training, and disrupted traffic on Francis Baard Street.
A striking cleaner at the Department of Labour, Boitumelo Motaung said she earns R6000 a month and supports a family of four people. She says she spends about R1000 on transport from Ga-Rankuwa to Pretoria for work.
“We are suffocating, and we are earning peanuts. I have three kids that are attending school and their father is unemployed. I am taking care of everything and a few days after payday, I am left without a penny and survive off loan sharks. We need government to recognise our value as people. Sometimes I am forced to do the work of three people where I work because they are not employing enough cleaning staff. That is why I am supporting this NEHAWU strike,” said Motaung.
Motaung said she has been working as a cleaner for seven years.
In a statement, DPSA director general Yoliswa Makhasi said work stoppages and pickets by NEHAWU and its members would be contempt of court.
“We will strike until our demands are met”
NEHAWU deputy secretary-general December Mavuso
Spokesperson for the department Moses Mushi said the minister had called on unions to return to the negotiating table.
NEHAWU deputy secretary-general December Mavuso said the strike had expanded. He said the union’s lawyers and government lawyers were in discussion about an appeal to the Labour Appeal Court. “We don’t know when an outcome will be available . In the meantime, our workers are on the picket lines,” said Mavuso. “We will strike until our demands are met”.
Department of Health spokesperson Foster Mohale said the department was working with provincial health authorities and law enforcement agencies to monitor the situation to ensure rapid response and if necessary urgent intervention.
In Fort Beaufort in the Eastern Cape, community health care workers were ordered to stop their services at clinics and hospitals. Striking NEHAWU members blocked the entrance of the Fort Beaufort Provincial Hospital and turned away patients. Top management was allowed to enter but other staff were locked outside the gates.
NEHAWU also shut down several government offices in the Eastern Cape.
Mphakamisi Shooter, regional NEHAWU treasurer, told GroundUp the union had used its resources to put President Cyril Ramaphosa in power. “But now he is failing to give us what we deserve.”
“We have over 5,000 members in this region. Today we made sure that we shut down all government departments in this region until Ramaphosa gives us a decent wage.”
MEC for Health Nomakhosazana Meth condemned the unprotected strike. “We understand that workers have a right to demonstrate but when they do they cannot infringe on the rights of others. We cannot afford to have a situation where the lives of patients and staff not on strike are in danger as a result of the action of those who have embarked on this action.”
She said there were reports of disruptions and acts of intimidation in some areas.
In Makhanda, clinics were closed as were the offices of the departments of Home Affairs, Labour, and Social Development by a group of about 80 protesters.
Madoda Toni, who was part of the protest, said the government cannot continue to pay workers low salaries while prices of food and other items were rising so fast. “We need permanent jobs, decent wage increases, and contract workers should be absorbed to be full time government employees and paid decent salaries,” said Toni.
In Qonce (King Williams Town) it was also reported that SASSA and Home Affairs offices were closed down by the protesters.
In Durban, patients were prevented from entering Prince Mshiyeni Memorial Hospital by NEHAWU members. The protest started about 6am and ended just before lunchtime when workers dispersed and returned to work. By 1pm, everything was back to normal.
Health activists demonstrating in Cape Town for a rise in the tax on sugary drinks were disappointed by Finance Minister Enoch Godongwana’s announcement in his Budget speech that the tax would be frozen for two years. Godongwana said this was “due to the difficult operating environment for the sugar industry from the impact of flooding and social unrest.”
The tax on sugary drinks was first introduced in 2018 to reduce consumption. The tax is imposed on drinks with more than 4g of sugar per 100ml. Research from the University of the Witwatersrand in 2021 showed that it has been effective in reducing the consumption of sugar-sweetened drinks.
HEALA, a coalition of organisations focused on nutrition, organised a flash mob in the Cape Town city centre ahead of the Finance Minister’s Budget Speech on Wednesday, advocating for an increase in the sugary drinks tax. They want the tax to be increased from 11% to 20%, following the guidance of the World Health Organisation.
The flash mob was part of HEALA’s “Less Sugar, More Life” campaign, and featured school pupils from Cape Town in a dance.
“We don’t even notice how much sugar we are drinking in sugary drinks and it’s harmful to our health. I want other young people to know that it’s dangerous,” said one of the dancers, Enkosi Stofile.
“The announcement by the Finance Minister, coupled with ineffective increases on other health taxes such as alcohol and tobacco, is a direct attack on the lives of millions of people at risk of serious health conditions such as diabetes, cardiovascular diseases and cancer,” said Nzama Mbalati, HEALA’s Programmes Manager.
Mbalati said there was no rationale for the decision to maintain the rate of tax on sugary drinks. “This decision is not in the interest of ordinary people. Instead, it puts profits ahead of people.”
About 10 000 new cases of diabetes are reported in South Africa each month, according to the International Diabetes Federation. Up to 70% of women and 39% of men are obese or overweight. Sugar is a cause of obesity and tooth decay, and is linked to a range of other non-communicable diseases. The national budget for 2023, tabled by Godongwana in parliament today, includes a R200-million reduction in health spending this year.
Before the budget speech, News24 reported that the South African Sugar Association said 6000 jobs could be lost if the tax was increased. SASA also said 9,000 jobs had already been lost since the levy was introduced.
However, in the aftermath of a fraud scandal at Tongaat Hulett, South Africa’s largest sugar producer, in 2018, 5,000 workers were served with retrenchment letters.
Disclosure: Community Media Trust does work for HEALA. GroundUp was once a project of Community Media Trust and still has a close relationship with Community Media Trust.
People living in Atlantis, Cape Town, say they are struggling to access healthcare. There are two clinics run by the City – Saxon Sea and Protea Park – offering limited care, concentrating on family planning, child health, basic antenatal care, and HIV care. For any other health issues, residents have to go to Wesfleur Hospital. People queue for treatment as early as 5am.
In 2017, we wrote about the long queues and other problems at Wesfleur Hospital.
Community activists have set up the Atlantis Community Health Organisation (ACHO), which submitted a memorandum of grievances in August last year to Western Cape MEC for Health Nomafrench Mbombo, and resident Allison Adams, (not part of the ACHO) set up an online petition that has garnered over 1,275 signatures.
Adams and ACHO want the two City clinics taken over by the province so that they can be upgraded to offer primary and not just general healthcare. This would take pressure off Wesfleur.
“Clinics would serve as a conduit to relieve the hospital from everyday attendance. The hospital can’t cope. We have limited number of doctors available every day,” says Ashley Poole of ACHO.
Adams says the doctors can’t cope with treating patients, doing ward rounds and conducting medical assessments for residents seeking disability grants. It takes days for people to get help at the hospital, she says, and everyone with even a minor illness has to go to the hospital.
“We have people traveling to Dunoon Community Health Center to seek medical attention,” she says.
ACHO wants a new hospital built in Atlantis, which in the 2011 Census already had nearly 70,000 people.
Mayoral committee member for health Patricia van der Ross said the City is open to transferring the clinics, but “the Western Cape health department must have the requisite budget available to continue running the clinics”. Then a handover agreement can be concluded.
She said a task team was established and “numerous meetings” were held explaining to the community the challenges involved in doing such a transfer.
One interim measure is that stable, chronic patients are seen at Protea Park three days a week on Mondays, Thursdays and Fridays between 8am and 4pm, and at Saxonsea clinic on Mondays between 8am and 1pm.
Provincial health department spokesperson Natalie Watlington said since receiving the memorandum in August 2022, the department’s district team has implemented short and medium-term interventions to improve matters at Wesfleur Hospital.
