Motsoaledi defends spending R9m on lawyers, says health dept being sued on several fronts over NHI

CAPE TOWN - Health Minister Aaron Motsoaledi said that his department was being sued on several fronts over the National Health Insurance (NHI) and was forced to hire twelve counsel.
Motsoaledi told the National Assembly that the legal team, which is made up of five senior counsel and seven junior counsel, had been paid R9 million to defend the department's universal health policy and the National Health Insurance Act.
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The minister was responding to questions in the House as part of the social services cluster of ministers.
Minister Motsoaledi was asked by the Democratic Alliance (DA)'s Michéle Clarke why he needed such a big legal team to defend the department at such a cost.
"I would like to ask the minister how he justifies paying for such a huge legal team, given that hospitals can't afford food for patients and overtime for doctors?"
Motsoaledi justified the cost, saying they were facing seven different litigations on two separate but related matters.
"We regard this team as appropriate. The president is suing for only one case. We are sued for seven cases. And this amount of money is those that have been involved in litigation, will know how expensive senior counsel is."
Motsoaledi also told MPs that medico-legal cases due to negligence were another costly burden but were mostly as a result of fraudulent claims.

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Daily Maverick

3 days ago

• Daily Maverick

Doctors slam trade union as working conditions in health sector deteriorate

A collective of doctors from across South Africa has lambasted the South African Medical Association Trade Union (Samatu) for failing to represent the interests of health professionals with many facing deteriorating working conditions. The doctors, from across South Africa, say their urgent call to Samatu to 'confront the deepening crisis' in the health system has fallen on deaf ears as junior doctors continue to face mass unemployment, and public-sector clinicians struggle with resource constraints and excessive unpaid overtime hours. On 26 May, 126 front-line doctors from more than 40 public and private healthcare institutions issued an open letter to Dr Cedric Sihlangu, general secretary of Samatu, calling for 'real' action towards addressing an exploitative health system. 'You call for dialogue – but dialogue with whom? With the very state that, year after year, has frozen posts, looted budgets, outsourced dignity, and now discards its doctors like broken tools?' the letter stated. 'Let us speak plainly. What is happening in Gauteng, Limpopo, Mpumalanga and everywhere else is not a technical oversight. It is the deliberate application of austerity in service of a political class that has no intention of delivering just, functional or universal healthcare. The goal is not to fix the system – it is to break it, hollow it out and contract it to the politically connected.' The letter also criticised the approach to the National Health Insurance (NHI) Act, stating that the NHI in its current form was not a path to equity, but a 'pipeline for centralised corruption, dressed up in the language of justice'. The collective questioned the union's efforts to 'build power from below', calling it a 'union of the few speaking on behalf of the many'. Among the changes it called for at the union were: The election of accountable leadership 'from below, rooted in struggle not ceremony'; The unification of employed and unemployed workers in one movement for workplace democracy; Preparation for 'real, coordinated action', rather than symbolic resistance; and Acknowledgement that the health system was not 'broken', but functioning to protect capital, contain labour and make politics profitable. 'Nothing to lose' Dr Simon Spoor, a spokesperson for the collective, said they had received no response from Samatu. He added that the network of clinicians had since grown to more than 1,000, represented on a WhatsApp group where they could share their concerns about problems in the health sector. 'The movement basically started with people beginning to get fed-up with the lack of response from our official doctors union, Samatu, who for years has been largely unaccountable and almost a non-entity when it comes to doctors and doctors' issues,' Spoor said. Samatu told Daily Maverick that it is aware of the open letter from the doctors' collective. It said that just 15 of the 126 doctors who signed the document were registered members of the union. 'Whilst Samatu would, on matters of collective concern, represent all doctors regardless of their union membership status, it is only fair that complaints similar to the ones encompassed in the letter be raised by members of our union only,' Sihlangu said. 'Samatu deems it frivolous for any doctor to claim that the leadership of the union is quiet on matters that affect doctors. More than other unions, and any other organisations that claim to represent the rights of doctors, Samatu has been at the forefront of addressing issues that affect healthcare workers, especially doctors, including bread-and-butter issues such as the unemployment of doctors.' On the matter of the NHI Act, Sihlangu said the union had been 'vocal' regarding its implementation, but added that there was a need for 'system change' in public healthcare. 'We need to allow the overdue systemic revolution in public healthcare, and currently that can only be done by allowing the NHI to take effect,' he said. Short-staffed and overworked Spoor noted that problems with the delivery of healthcare in the public sector are often blamed on individual workers or particular facilities. 'The system refuses to acknowledge the systemic nature of the problems we're facing, that the public is also kept in the dark about. It's reached the point where we can't, in clean conscience, allow it to go on any longer,' Spoor said. 'We're not doing this, in our own collective, just for ourselves. It's really for the patients that we serve. No doctor likes to… see your grandmother sitting there for six hours waiting to get treated for a heart attack… and if you do that on a day-to-day basis, it starts to grind you down. At this stage, we felt like we've got nothing to lose, and we have a moral duty, because if we don't speak out… then nobody will.' The open letter to Samatu was released shortly after unilateral policy amendments by the Gauteng Department of Health (GDOH) to reduce commuted overtime contracts for doctors. Samatu released a statement on 4 April stating that it had met with the department and ensured a three-month suspension of the implementation of the proposed changes, pending a consultation process. However, the collective behind the letter argued that the GDOH's actions are only a symptom of much deeper problems. 'Doctors have always worked more overtime hours than what they're paid for, but now they're pushing it so that they are expecting all doctors to work a minimum of 80 hours overtime a month… And in some places… they're expected to work up to 170 hours a month,' Spoor said. The accounts of doctors in the collective's network were shared with Daily Maverick under condition of anonymity to protect them from professional backlash. One doctor from the Eastern Cape said that overtime hours for certain specialities, such as ophthalmology and urology, were dropped at their health facility between April and May. This resulted in general practitioners having to handle specialist cases that came in after hours, as the required clinicians were not present. 'Their wake-up call was when patients started dying like flies… There were also bottlenecks in casualty because most departments would not accept patients over weekends due to lack of cover,' the Eastern Cape doctor said. Another doctor claimed that while they were contracted to work 80 hours overtime per month, they consistently worked between 100 and 114 hours. 'I am not compensated for the extra hours worked. I confronted HR at our workplace and was made to feel guilt for questioning why I am doing unpaid extra hours. He even said he is disappointed in me,' the doctor said. 'It's taking a toll on my mental health… because I have to study, do multiple courses that I will use to apply for a permanent post… but I am constantly exhausted and my time is being stolen by the hospital. 'I am human too, I am not a machine. I am not solely my job.' Spoor said that in 10 years in the public sector, he had never seen morale among doctors at 'such a low point'. Daily Maverick reached out to the National Department of Health about the reports of poor working conditions for doctors in the health sector but had not received a response at the time of publication. According to Samatu, 'the issue of commuted overtime downgrades started in Limpopo, and there is an ongoing litigation process between Samatu and the Limpopo Department of Health, whereby the High Court ruled in favour of Samatu and interdicted the implementation of a flexi-shift system. It cannot be that Samatu would be willing to advocate for doctors in Limpopo on this issue and not be willing to do it for those in Gauteng. Just like any organisation, we must strategise on how we tackle issues like this one, for the benefit of our members.' Making a change Samatu's election policy states that an individual can only be elected as a national office bearer when they have been a member of the union in good standing for eight years or more. Its constitution states that shop stewards can be elected at workplaces where the organisation has a minimum of 50 members. Spoor said these requirements exclude many doctors from accessing representation or leadership positions at the union. 'Our view is we need to build something new from the ground up,' he said, adding that the collective had plans to establish a voluntary association to represent doctors, with the aim of expanding into a 'fully fledged union'. 'We're trying to do this very democratically… but with a few basic assumptions that we all seem to agree on, which is that every institution should be able to have a representative… We want to set up a structure where leadership is recallable at any time and mandates can be made from the rank and file,' he said. Sihlangu told Daily Maverick that all members of the union qualify to contest for positions, provided their membership status is in order. 'Just like any other union, Samatu has a constitution that the organisation must adhere to, as well as the Labour Relations Act… Section 14(2)(a) to (f) of the Labour Relations Act clearly stipulates the requirements that must be met by every union to elect trade union representatives in workplaces,' Sihlangu said. DM

Daily Maverick

5 days ago

• Daily Maverick

Minister Motsoaledi's big HIV treatment jump: Is it true?

More than half a million people previously diagnosed with HIV have started on HIV treatment since the end of February, the health minister says. But can a big jump in 10 weeks really be? We look at the numbers At a glance Last month, the health minister said that more than half a million previously diagnosed people with HIV have been started on treatment since the end of February. But can it really be, especially since the gap to getting 95% of people diagnosed with HIV on medication has been hovering around 1 million for the past five years? Critics say they're sceptical about the minister's figures, and that the country will close the gap by December. We dive into the numbers to see what the picture looks like. Numbers are powerful. They can also be dangerous — if not used correctly. When the health minister said last month that 520,700 more people previously diagnosed with HIV have started on treatment since the end of February, the number sounded astounding. The health department's goal before the end of the year is to find 1.1 million people who know they have HIV but have either never started treatment or fell out of treatment. In his words, the department has reached 'more than 50% of the target' it set out to achieve by the end of the year. If that gap is closed, South Africa would have met two of the three so-called 95-95-95 goals the country signed up for as part of the United Nations plan to end HIV/Aids as a public health threat by 2030. However, knowing exactly how much the gap is closing is tricky, because people who know they have HIV may start and stop and then restart treatment again later – sometimes several times – during the course of their care. In fact, a study from the Western Cape shows that close to half of people on medication stop at least once, and that some even pause and then restart up to three times. So, many of the 520,700 previously diagnosed people Motsoaledi says are now on medication could, at least in theory, very well be people who are counted repeatedly as they cycle in and out of treatment. But because the patient information system isn't digitally centralised – most clinics still keep track of their clients on paper, which means different facilities can't easily access one another's records – someone who stops treatment at one clinic can easily be counted as a new start at another, rather than a restart. The set of UN targets aim for 95% of people in a country with HIV to know their diagnosis, 95% of those being on treatment and 95% of those taking medication having such low levels of virus in their bodies that they can't infect someone through sex. 'The reason that we [were] able to reach half a million within a short space of time, was because of weekly check-in meetings with provinces, where reports that come from the ground are verified in the presence of all provincial colleagues before they are regarded as final figures for reporting,' the minister said. But simply counting better isn't the same as doing better, and critics called the reported progress 'inconceivable'. Why? For the last few years, the number of people with HIV who have gone on treatment has crept up very slowly, so much so that the gap to 95% has remained more or less the same for about five years. (At the moment just more than 80% of people diagnosed with HIV are on treatment.)* Moreover, that was while treatment programmes had funding, and US-backed money for HIV projects was in place. So now, at a time of funding shortfalls, the closure of programmes and the government scrambling to plug the holes, could nearly half of the number of people who need to get treatment really have been added in just 10 weeks? We dive into the data to get a sense of what the numbers really mean. Mind the gap In 2021, South Africa was about 1.2 million people short of its 95% treatment goal; by 2025 the shortfall will likely be 990,000. That means that the gap – that is, the difference between where the country actually is and where it wants to be when it comes to HIV treatment – has closed by about 210,000. So there's been progress, but it's been slow: in total, only about 700,000 more people are on HIV medication today than five years ago. 'Getting that last 1 million or so people on treatment is not simple,' says Kate Rees, public health specialist at the Anova Health Institute. Part of the reason for this, she says, is that a large proportion of the group needed to close the gap are people who have in fact been on antiretrovirals before, but have since stopped. Sometimes people miss an appointment to get a refill of their medicine because they can't afford to take time off work to go to the clinic ,or they might have moved to another province or district and so they don't go back to the facility where they first got their prescription, she explains. The longer the interruption lasts, the more hesitant people are to go back, she says, because they dread being treated poorly or getting 'kicked to the back of the queue' for having missed an appointment, with people such as sex workers, trans folk or men who have sex with men especially facing judgement. 'The health service expects people to be very rigid with their appointments, but life just is not like that,' Rees says Slow progress To get a sense of the progress towards meeting the UN's second target in its 95-95-95 cascade, it's best to look at the difference in the total number of people on HIV treatment from year to year, says Leigh Johnson, one of the lead developers of the Thembisa model, which is used to report South Africa's official statistics to UNAids. Although the number of people on medication is increasing, the number grows less and less each year. For example, in 2020, about 291,000 more people were on treatment than in 2019. By 2021, though, the number had grown only by about 225,000. Current forecasts from the model are that the total number of people on treatment will grow by only around 160,000 this year. But that's based on programmes running as they have up to now — and with recent upsets because of US funding cuts, it may be an unreasonable assumption, Johnson says. Part of the reason for the small net gain every year is that although many people sign up for medication in a year, many also stop coming back to get their scripts refilled. Of those who drop out of treatment, some might choose to restart within a couple of months again, while others may pause their treatment for more than a year. In 2023, for example, roughly 793,500 people who had been on treatment before weren't any longer, but about 728,000 who received medication were restarters, Thembisa numbers show. So even though some people who stop taking their medication might not restart – or restart quickly –the total number who are on treatment still grows; it's just slow-going. This means getting a handle on how close to – or far from – the 95% treatment mark South Africa is, is more dynamic than simple addition. Stops, starts and restarts 'There will always be people who interrupt their treatment,' says Rees. 'It's not possible to keep everyone perfectly in the system all the time — that's life.' But what's important, she says, is to make those pauses as short as possible by helping people to get back on medication quickly and easily – without judgement. Gesine Meyer-Rath agrees. She's a health economist at HE2RO, a health economics research group at the University of the Witwatersrand, and focuses on how the government can get the most bang for its buck in its HIV programme. Data in the Thembisa model shows that over the years, the number of people starting medication for the first time – in other words, those who have never been on treatment before – has shrunk, but at the same time counts of restarters have grown. Her group's analyses have shown that honing in on keeping people on HIV treatment is the best way to go – especially now that funding is shrinking – and that 'we can close the 1.1 million gap through improved retention alone'. But to plan sensibly, she explains, policymakers should know how many people are first-time starters, how many pause treatment but then restart, and how many stop and don't come back at all. 'The more detail programme planners have in the data, the better,' she says. 'The [government's] Close the Gap campaign has a lot of good ideas, but having the right numbers of where the gap is that we want to close is crucial, as is keeping these numbers accurate as we progress.' This is exactly where things can become tricky in future if the holes left by the US funding cuts aren't plugged. Because of the US aid withdrawal, about 40% of South Africa's HIV data capturers will likely have lost their jobs by September, Bhekisisa reported last month, and this means the information needed to shape where money has to be spent to make real progress in ending Aids as a public health threat over the next five years simply might not be available. 'The less data we have, the more we're flying blind, which leaves space for bickering over the data that is still there,' says Meyer-Rath. DM

The Citizen

13-06-2025

• The Citizen

New Covid variant raises concern over vaccine access

Experts urge South Africa to license updated vaccines as a new Covid variant spreads globally but hasn't reached SA yet. If South Africa wants to intensify its fight against the new Covid variant that might hit the country, it should consider having vaccines available and licensed locally, according to health experts. The World Health Organisation recently announced that the new variant, which was detected in Asia a few weeks ago is gaining momentum globally. The National Institute for Communicable Diseases has confirmed the NB.1.8.1 variant has not yet been detected in South Africa. New Covid variant not yet detected in SA Prof Shabir Madhi, a health expert from Wits University, said: 'Unfortunately, there are no Covid vaccines available or licensed in SA. This is concerning, as highrisk people do require at least annual boosting with the most recent variant vaccine. 'The vaccine currently available elsewhere would provide some protection against NB1.8.1, but less so compared to the variant (JN) which is targeted at.' ALSO READ: The price of distraction: South Africa's allergy to the truth He said licensing the vaccines in the country was important because the high-risk individuals still remain susceptible to severe disease and it's the only option that can reduce their risk of severe illness from Covid. Madhi said the surveillance for Covid has significantly diminished over the past few years in SA, while there was data to support the virus has been circulating at low intensity since 2023. 'We have recently had an annual outbreak of respiratory syncytial virus, which is on the decline. Also, there is an increase in influenza over the past two weeks, which is now beginning to dominate,' he said. Proactive planning and investment Dr Bandile Masuku, chief patron of the national campaign for epidemic preparedness funding and budgeting, said it was important for the country to conduct proactive planning and investment, particularly in Gauteng. 'South Africa, and especially Gauteng, learned hard lessons from the Covid pandemic,' said Masuku. ALSO READ: Special Tribunal declares R600m AngloGold Ashanti Hospital contracts unlawful 'Today, we are better equipped, but we must not be complacent. Preparedness is not a luxury; it is a necessity. Let us not wait for a crisis to occur. Let us fund, plan and prepare because preparedness saves lives.' Health Minister Dr Aaron Motsoaledi has urged the public not to panic. He said South Africa was actively monitoring the emergence of the variant and had a robust surveillance system in place. Don't panic – Minister Motsoaledi 'Currently, our data shows very low Sars-CoV-2 activity. While we are observing a seasonal increase in influenza, we are well-prepared to manage this,' said Motsoaledi. He said at this stage, no specific new public health actions are required from the public. ALSO READ: Covid pupils triumph with record matric results Motsoaledi also urged the public to maintain good hygiene practices, such as hand-washing, covering coughs and staying home when not feeling well.