MTN’s move came after Afrox, a major oxygen and gas provider to health facilities, threatened, in July, to cease supply of its lifesaving products if its account was not settled.

The chief sustainability and corporate affairs officer at MTN South Africa, Jacqui O’Sullivan, declined to comment on the MTN matter, saying: “The details pertaining to customers’ accounts are confidential and we would therefore refer you to the Eastern Cape’s department of health for comment.”

Provincial health spokesperson Yonela Dekeda said MTN has been contracted to provide telecoms services to the department since December 2021. She admitted that the department owes MTN, but declined to reveal the total amount owed.

Spotlight understands that a payment agreement has since been reached and services have been restored. 

The non-payment of suppliers by the provincial health department, however, is not only affecting MTN – several other service providers have also withdrawn, or threatened to withdraw, their services, citing non- or late payment. These include those contracted by the department to offer critical services such as oxygen provision, provision of surgical consumables such as orthopaedic implants, and provision of equipment for use in theatres. Spotlight also previously reported on a strike of security companies following non-payment. 

Madwaleni Hospital near Elliotdale is one of the hospitals servicing the people of the Xhora Mouth area in the Eastern Cape. (Photo: Alicestine October / Spotlight)

Dekeda declined to provide a breakdown of the amounts owed by the department to different suppliers since the department is still in negotiations with different suppliers.

‘For the sake of patients’ lives’

Eastern Cape health MEC Nomakhosazana Meth said in June, in a response to a written question in the Eastern Cape legislature, that the department owed R4-billion to suppliers of medicines and medical supplies, including medical implants, equipment, oxygen and anaesthetic gases.

Meth said her department would not be able to pay all its debts due to limited funds meant for goods and services.

“The department will keep negotiating with sister departments and defer payments that are likely to arise as a result of equitable share depletion. An unaudited payment of R3-billion has been paid in April now and it will be audited by 31 July 2023. The department would pay major suppliers the conditional grant and equitable share portion of the budget who render services within its ambit,” she explained at the time.

“Where the equitable share portion gets depleted, the department will negotiate with major suppliers to continue supplying the service, for the sake of the lives of the patients. Where the suppliers only fall under the equitable share portion, it will pay the minimum from the available portion of the budget and continue to negotiate for the uninterrupted supply of services.”

Dr Rolene Wagner, head of the Eastern Cape health department (left), with health MEC Nomakhosazana Meth during an earlier presentation of the Human Rights Commission’s provincial inquiry into the right to food and malnutrition. (Photo: SAHRC / Twitter / Spotlight)

In June, during her budget speech, Meth said of the R28-billion budget that just more than R7-billion had been allocated to goods and services, and 68% – about R19-billion – was going towards employment costs. All in all, she vowed that 82% of the total budget was meant for “direct patient and health services”.

Owing billions

But DA MPL and health spokesperson in the Eastern Cape, Jane Cowley, slammed the department earlier for poor financial management. “How can it be that a department must beg for extended credit to ensure that patients don’t die?” she asked.

“About R28-billion has been allocated to the Eastern Cape health department this financial year and only 9% (about R2.53-billion) will be set aside for goods and services such as telecoms services, surgical consumables, and more importantly, life-saving medicines and medical equipment,” Cowley says.

Cowley argues that the department’s already limited budget is not efficiently spent. For example, “of the R23.38-billion left after accruals are deducted, the compensation of employees takes up 81% of the remaining budget.” This adds up to R19-billion, yet “critical medical posts remain vacant”.

Read more in Daily Maverick: Too scared to come to work, nurses say amid rising security concerns at Eastern Cape health facilities

As in other provinces, the Eastern Cape is having to deal with the fact that salary increases in the public healthcare sector in recent years have not been matched by equivalent increases in health budgets.

Cowley said almost 17% of this year’s R28-billion health budget allocation should be going to pay off debt from previous years.

Accessing healthcare services is a struggle for many in the Eastern Cape’s rural areas. (Photo: Black Star / Spotlight)

“This comprised only a small percentage of their accruals, which amounted to R4.7-billion. Several small and medium suppliers have cut their losses. Some have been forced to close their doors. Bigger companies have adopted a zero-tolerance approach to carrying this outstanding debt, in some cases for years, and are now taking action,” she told Spotlight.

In her earlier statement she said: “I have written to the Minister of Health, Dr Joe Phaahla, to highlight the catastrophic impact of this poor fiscal management and maladministration on the most vulnerable in society, the patients who depend on this department for their health and well-being.”

‘No health facilities were affected’

Dekeda told Spotlight the impact of MTN temporarily pulling the plug on telecoms was limited to officials and “no health facilities were affected”. Only officials’ mobile phones had been suspended by MTN on 11 August.

“But when this suspension was escalated to the accounting officer (superintendent-general of the health department), there was an engagement with the CEO of MTN with the view to ensure the restoration of the service. There are no health facilities that were adversely affected by this, only official mobile phone users,” she said.

“There were contingencies that were in effect, as the department has Telkom as another service provider for landlines, a push-to-talk system, and Telullars (a wireless terminal) that are provided for officials who have to work over the weekends. This is part of our systems to promote business continuity in the event there is a breakdown of the official cellular system.”

All Saints Hospital in the Eastern Cape. (Photo: Siyabonga Kamnqa / Spotlight)

Dekeda said: “The suspension of the accounts over the weekend affected all the employees that are in possession of official cellular phones in the department. There were no adverse events reported, as this happened over the weekend. The department diligently worked around the clock with MTN to resolve the issue, as such, telephone lines are confirmed to have been restored.”

However, that same week Spotlight called several health facilities, including Madzikane ka Zulu Memorial Hospital in Alfred Nzo District, Aberdeen Hospital in Sarah Baartman, Madwaleni Hospital in Amathole and Frere Hospital in Buffalo City, to check whether calls were going through. This followed healthcare workers and residents alerting Spotlight to difficulties with phone lines to some facilities.

Some calls to landline phones did not go through or were directed to reception before being dropped, while at some hospitals there were recorded automated messages on switchboards that said “phones were not serviced”. 

Spotlight has not been able to establish whether these issues (and those described below) were caused by the situation with MTN or something else.

Dekeda insists no facility was affected by the situation with MTN. 

On 16 August, a reliable source at a referring hospital told Spotlight it seemed that the Cecilia Makiwane Hospital and Frere Hospital lines were down. The source confirmed that the department’s cellphones were also affected but said it seemed they had started working again on 15 August. The same source said the district hospitals’ lines had not been affected and were fine. The source is not named given the risk of victimisation.

“We were working at Frere with no landlines. There are two cellphones at the switchboard and that is how we reach Frere,” the source said. “Other than that, the different departments at Frere have shared the doctors’ numbers on call so doctors are discussing directly with them. The disruption didn’t affect the sick patients as there is no real difference for them because we usually have to speak to the doctor directly. But it is very frustrating now when making a non-urgent appointment for a patient as we usually phone the landline and speak to a nurse working in the department who has an appointment book.”

Bonisile Buso from Peddie said he spent hours over that weekend trying to reach Frere Hospital after learning that his injured son had been admitted to hospital. He said he was furious when he couldn’t reach staff at the hospital to inquire about his son’s condition. He only learnt later that the telephone lines to that hospital were not functioning. 

According to Buso, a nurse (from Peddie) called her colleague at Frere Hospital on her personal phone and was told the lines were down. “As that nurse was not on duty at the time, she was unable to assist us. The fact that I could not reach the hospital for updates on my son’s condition upset me and made me panic. Having been transferred from one hospital to another, his condition was critical,” Buso said. “So I hitchhiked to East London, desperate for news about his condition. He is doing well now, however.” DM

This article was published by Spotlight – health journalism in the public interest.