EXCLUSIVE: Apathetic governance threatens Limpopo healthcare system collapse


Ayanda Mdluli

The provincial healthcare sector in Limpopo is on the brink of collapse and is failing scores of people from impoverished communities.


Communities who are in desperate need of nutritionists have not been absorbed into the system and are instead languishing at home in the pits of unemployment despite being registered healthcare professionals with regulatory industry bodies. This despite a grouping of 100 nutritionists and dietitians offering their services to the provincial government which has highlighted the need for their services.


Many healthcare professionals in the province have blamed the system failure on widespread incompetence and maladministration as virtually no professional nutritionists and dietitians are available to treat hundreds of thousands of poor people in community clinics.


Limpopo hospitals are overcrowded with poor people queuing for services such as kidney dialysis, limb amputation, chemotherapy radiation, cardiac bypass, as well as severely malnourished HIV/AIDS and TB patients. Thousands of these people cannot afford private healthcare and government appears to be indifferent to their plight despite billions being allocated to provide relief.


On a daily basis, the healthcare system in the province is grappling with children being admitted with severe undernourishment, low birth weight and children dying of diarrhoea, pneumonia, measles, malnutrition and other diseases.


This is all happening despite there being hundreds of nutritionists and dieticians sitting at home unemployed. A group of more than 100 nutritionists have finally had enough and blew the whistle by putting together a petition and a grievance requesting radical changes to be implemented in the province’s healthcare system.


According to the nutritionists who spoke to Africa News 24-7, the province has access to billions of rands worth of funds to ensure that communities receive essential services yet there is still a major shortage of personnel and equipment in community clinics. Among the main grievances is that there are no full-time nutritionists or dietitians that are available to render services in Limpopo clinics.


According to Arole Shivambu, a nutritionists and leader of the collective of healthcare professionals who signed the petition delivered to the provincial health department, 90% of the employed nutrition workers are found in government hospitals while only 10% have been made available to community healthcare centres where many diseases should be prevented and managed.


“Our patients are given googled diets by other healthcare and general workers in our clinics who are not qualified nutritionists while scores of qualified nutritionists are sitting at home unemployed even though there are vacancies that are available with funds to pay them decent salaries,” he said.


Shivambu said that the Limpopo Health Department, under the leadership of Phophie Ramathuba who serves as its MEC, is failing to get the basics right.


“Regular prevention and management of all the nutrition-related diseases and conditions at a community level will reduce overcrowding in our hospitals and save billions. However, at this rate we are afraid the budget will keep on increasing if no urgent steps are taken. All district primary health care managers, district nutrition managers and clinic managers in the Limpopo province have been raising the issue surrounding the shortage of nutritionists but their cry has been falling on deaf ears,” he said.


Furthermore, the crisis has been exacerbated by the fact that the MEC has failed to absorb qualified nutritionists into the provinces’ healthcare sector. In 2016, Ramathuba made an announcement that unemployed nutritionists and dietitians should not wait for posts to be advertised. Instead, upon completing their degrees they should go directly to the government health facilities and submit their CVs as they possessed important rare skills that will help prevent and manage many diseases that are compromising our health system.


“In light of the MEC’s announcement, a list signed by 111 qualified nutritionists was submitted to the nutrition director and Ramathuba in Limpopo on the 19 April 2018 and 31 May 2018 respectively. We highlighted the above and raised gaps and problems for them to at least employ nutritionists/dietitians in our community clinics. However, they never responded till this day. A systematic follow-up was made to the offices of the MEC and nutrition director through phone calls but nothing positive came out of it. We sent an email to the head of department at the Limpopo Department of Health asking for a meeting on the 12 June 2018 and no one has even acknowledged our email,” explained Shivambu.


An apathetic government

Africa News 24-7 sent a series of questions to the Limpopo Department of Health and did not receive a response. The email was sent to three individuals in the department who deal with media and communications as well as Ramathuba’s office yet there was not even an acknowledgment of receipt.


To further exacerbate the situation, unemployed nutritionists, while struggling to make ends meet, must contend with paying an annual fee to register as professionals with the Health Care Professions Council of South Africa.


“According to the HPCSA, under section 61A of the Health Professions Act Number 56 of 1974, as health professionals we are obliged to pay a registration fee of R2,400 which is followed by an annual fee of R1,671. We are expected to pay despite our unemployment status and poor backgrounds. We went to school to take our families out of the poverty cycle, but it looks like we have made the poverty walls higher,” he said.


Lagging on global targets

The World Health Assembly (WHA) has set nutrition targets that must be reached by 2025 and South Africa, particularly the Limpopo government, is lagging far behind. The targets stipulate that there must be a 40% reduction in the number of children under five who are stunted and a 50% reduction of anaemia in women of reproductive age (pregnant and non-pregnant).


In addition, there must be a 30% reduction in low birth weight and no increase in childhood overweight problems. The WHA also highlighted that there needs to be an increase in the rate of exclusive breastfeeding in the first six months up to at least 50%.


According to studies, many babies in Limpopo are breast fed after birth, however, 90% are introduced to solid foods as early as two months old despite SA’s healthcare policy stipulating that a child must receive breast milk from birth up until the age of six months.


Policies further state that the introduction of complimentary food must happen at the age of six months.


“Despite the importance of this policy, no nutritionists are employed on a full-time basis in community clinics to make sure mothers and guardians adhere to this policy. If all the gaps were filled at a community level, we would not be having people admitted in hospital because of non-communicable diseases,” said Shivambu.


The department spends billions of rand trying to fix these problems, yet nothing is done to prevent them at a community level.


“Only 43 nutritionists remain employed in the province of more than 452 clinics, 26 community health centres and at least 32 hospitals. Only 10% of dietitians and nutritionists are found in our communities to help prevent and manage these diseases and conditions,” added Shivambu.