Here is the evidence

Issued by:
Derek Luyt
Media and Advocacy Head
Public Service Accountability Monitor (PSAM)
Tel: +27 (0) 46 – 603 8830/8358
Cell: +27 (0) 0722533957
Fax: +27 (0) 46 – 622 7215

The evidence President Mbeki needs to sack Health Minister Manto Tshabalala-Msimang is contained in Auditor-General’s reports.

If President Thabo Mbeki needs evidence for the removal of Health Minister Manto Tshabalala-Msimang, he need look no further than the Auditor-General’s and Annual Reports of South Africa’s national and provincial Health Departments.

These reports show that, during her time as Minister of Health, Tshabalala-Msimang has failed to ensure two things fundamental to the progressive delivery of health services in South Africa.

Firstly, she has failed to ensure adequate financial management within her Department, thus eroding the effective delivery of health services in the country.

Secondly, she has failed to ensure a reduction in the critical shortage of skilled health workers in South Africa, thus contributing directly to the continuing inadequacy of health services in the country.

As Minister of Health, Tshabalala-Msimang is ultimately responsible for the effective functioning of the Health Department, yet the national Department of Health has received qualified audit opinions from the Auditor-General (A-G) for the last three financial years. A qualified audit opinion is expressed when the A-G identifies deficiencies in financial management which have a negative impact upon the financial statements of a department.

The National Department of Health transfers approximately 90% of its annual budget to the nine provinces by way of the Division of Revenue Act (DoRA). This Act requires the Department to maintain acceptable levels of monitoring and control over conditional grant funds transferred to provinces. These funds are intended to realize citizen’s rights to access acceptable levels of health care, as required by our Constitution.

In 2003/04, the Department transferred R7 billion (91,4 percent of its budget) to provincial Health Departments. The A-G noted “fundamental deficiencies and non-compliance with the provisions of the Division of Revenue Act”, including that “financial and operational monitoring of compliance with conditions of conditional grants were not adequately performed by the department.”

In 2004/05, the A-G noted once again that transfer payments of R7,4 billion (87.4% of its budget) had been made to provincial departments and that there were “material areas of non-compliance with certain provisions of the Division of Revenue Act” due to “capacity constraints in the department.”

In 2005/06, the Department transferred R8.8 billion (89 percent of its budget) to the provinces, and again the A-G noted areas of non-compliance, including payments of R1.3 billion made “prior to the approval of business plans”. Amongst other things, the A-G also found:

– late or non submission of monthly financial reports by provinces resulting in the national department not being able to properly monitor expenditure;
– late or non submission of quarterly performance reports by provinces, resulting in the national department not being able to properly monitor the performance of provinces;
– quarterly visits to provinces were not always conducted.

The Minister has also failed to ensure that her accounting officer has maintained oversight over the financial management of provincial departments. In the 2003/04 financial year, six of the nine provincial departments received qualified audit opinions. In 2004/05 four provinces received qualified audit opinions, and in 2005/06 five provinces received qualified audit opinions. Some provincial departments have even received audit disclaimers (issued where the A-G does not express an opinion due the extent of financial irregularities/deficiencies identified). The Eastern Cape Department of Health has received seven audit disclaimers during the eight years Minister Tshabalala-Msimang has been in office.

With regard to the staffing of the public health system, while Minister Tshabalala-Msimang’s Department is in the process of finalizing a national human resources plan, the fact remains that the vacancy rate of skilled health workers in the South African public health sector has grown from 27,2 percent in 2005 to 33,3 percent by the end of March 2007. It has taken far too long to implement an effective human resource plan aimed at ensuring the recruitment and retention of staff. The Minister must be held accountable for her Department’s inability to reduce the critical shortage of health workers in South Africa, which contributes directly to the inadequacy of heath care services in the country.

Minister Tshabalala-Msimang has clearly failed to address the most critical aspects facing the public health system in South Africa. She has failed to ensure acceptable levels of financial accountability in the Department, failed to exercise oversight with respect to poorly performing provincial Health Departments and failed to implement an effective staff recruitment and retention strategy.

South Africa’s health services have been compromised as a direct consequence of these failures which are a matter of public record, and President Mbeki should be aware of them. South Africa faces extraordinary challenges in delivering health care to its people. It is President Mbeki’s responsibility to ensure that the post of national Health Minister is filled by someone capable of meeting these challenges.