Eastern Cape Health Crisis

28 March 2015


 “I am grateful to hear that the government provides these things called ambulances. I have never seen an ambulance in my area.” – testimony from Xhora Mouth resident

EAST LONDON, 27 March 2015 – Two years ago, Nqileni Village in the Xhora Mouth area laid a complaint with the South African Human Rights Commission (SAHRC) about the lack of emergency medical services (EMS) in their community. On 25 and 26 March 2015, the SAHRC held a provincial hearing on EMS in the entire Eastern Cape province. The panel, comprising Deputy Chair Pregs Govender, Commissioner Bokankatla Malatji and Dr Prinitha Pillay heard from community members from four areas in the province, as well as from representatives of the provincial Departments of Health, Planning and Treasury, and Roads and Public Works.

The statements of and stories emerging from the communities represented at the hearing were tragic and moving. The hearing heard from Xolisile Sam of Isilatsha Village, who lost his sister after five days of struggling to get an ambulance to attend to her; from Zukile Madikizela of Lusikisiki who spoke of the range of steps he took to secure an ambulance and emergency care for a patient over the course of ten days. Nomalinge James, a village health worker in Nier Village, spoke of the high mortality rate of babies in her village as a result of the lack of ambulance services. For her, the centralization of ambulance call centres has been problematic because villagers from Nqushwa Village have to call East London and hope that the call centre agent would be able to describe their location (where there are no addresses and people rely on knowledge of the local terrain). This accentuated the problem, with the few ambulances that may have been dispatched getting lost.

The hearing had the feel of a truth and reconciliation commission. Department officials shifted in their seats as people from across the province described the loss of children, parents, siblings and neighbours and the financial implications of having to pay for transport using their grants to ensure that loved ones access care in an emergency because ambulances never arrive.

The Superintendent General for Health, Dr Thobile Mbengashe, and the Chief Director of Clinical Support Services, Mr Sibusiso Zuma, were among those who made statements and answered questions. The short time available meant that the questions of the panel could not all be answered and the Departments have two weeks to respond to outstanding questions. A report from the Human Rights Commission, making recommendations on steps to be taken, is expected in 60 days.

Emergency Medical Services are an essential part of our right to health. ECHCAC congratulates the SAHRC for holding this hearing. Enormous expectations have been raised. ECHCAC awaits the report and commits to ensuring that the recommendations will be carried out by the government. We are committed to ensuring that the unnecessary loss of lives, as well as community members’ out-of-pocket expenditures for private cars ends. We have suffered for too long.

Many community representatives lamented the lack of engagement with various provincial departments. Information provided by the Department of Health in particular was deemed inconsistent and insufficient by the panel. ECHCAC urges the various departments not to wait for the SAHRC’s report and to ensure that they follow the Batho Pele principles, which espouse openness and transparency and extensive and regular community engagement, among other things.

ECHCAC also urges the provincial Department of Health in particular to apologise to the people of the Eastern Cape for the unnecessary loss of countless lives as a result of the state of ambulance services. These could have and should have been avoided.

For more information, please contact:

Fikile Boyce, ECHCAC coordinator, 073 080 5379

Mluleki Marongo, 078 105 8802

For media related queries, please contact:

Ngqabutho Mpofu, SECTION27, 061 807 6443

Mary-Jane Matsolo, Treatment Action Campaign, 079 802 2686


Update 13 August 2014

Article from www.health-e.org.za

Civil society groups threaten to sue Eastern Cape Dept of Health
By Laura Lopez Gonzalez on August 8, 2014

Activists from more than 30 civil society organisations have again threatened to take the Eastern Cape Department of Health to court over alleged failure to fix the provincial health services.

The organisations - which are part of the Eastern Cape Health Crisis Action Coalition (ECHCAC) - also plan a mass mobilisation of communities behind their demand for a health service delivery plan.

This follows the failure of the new health MEC, Dr Phumza Dyantyi, to provide the coalition with such a plan, despite being given two months to do so.

The health challenges include medicine, staff and ambulance shortages; no wheelchairs, huge waiting lists for orthopaedic and other operations.

"Commitments to fill vacant nursing posts have not been kept. The provincial department has failed to employ newly trained enrolled nursing assistants and nursing assistants despite the desperate need for them," the Coalition said in a statement released yesterday.

The coalition has again asked for an urgent meeting with provincial leadership, and warned of court action "to protect the rights, heath and lives of citizens".

However, coalition member Section27's John Stephens declined to outline a deadline within which the department should act to avoid litigation.

The ECHAC received communication from new Eastern Cape Premier Phumulo Masualle shortly after he entered office. Masualle had requested time for MEC Dyantyi to compile a report of how the coalition's concerns had been addressed and the drafting of a strategy to address outstanding issues.

More than two months later, Dyantyi has not yet delivered, according to the statement. However, the Eastern Cape Department of Health says moves are being made to address concerns.

New health vehicles delivered, vacancies being fixed - department

"A lot has been achieved in addressing issues raised by the coalition," said Eastern Cape Department of Health Spokesperson Sizwe Kupelo. "Going to court might not be the best option given progress and change in political leadership."

According to Kupelo, the department remains ready to meet with the civil society delegation. He added that Dyantyi recently handed over 167 emergency medical services (EMS), forensic and other vehicles.

"We are always ready to meet any citizens wanting to discuss health of our people," Kupelo told Health-e News. "Staff shortages have and are being addressed and the new MEC has declared zero tolerance to non-service delivery."

He added that health facilities could also expect surprise visits from the MEC and senior managers.

"The MEC and senior managers are going to districts and hospitals as part of a rapid response team intervention to assess service delivery levels," said Kupelo, adding that certain financial and human resources functions have been decentralised away from provincial capital of Bisho to improve efficiencies.

According to Kupelo, Dyantyi has also declared that all posts need to be filled within three months of being vacated. A deputy director general of clinical services has been appointed, while the EMS head position will be re-advertised early next week and other posts within that department have already been filled, he added.

The coalition of more than 30 civil society organisations was born following the September 2013 release of a damning report on provincial health systems by the AIDS lobby group Treatment Action Campaign and Section27.

The report alleged that health facilities were running with half the doctors needed or less and that nurses often carried a patient load more than twice the national average. Hospitals like Mount Frere and Cecilia Makiwane were also alleged to have closed operating theatres or were turning away mothers in need of Caesarean sections.

In March, Health-e News reported stock outs of childhood vaccines in the province's OR Tambo and Alfred Nzo districts, but citizen medicine monitors working in selected clinics have not recorded stock-outs since then.


Update & Campaign History 07 August 2014


 EAST LONDON - The Eastern Cape Health Crisis Action Coalition (ECHCAC) was founded on 7 June 2013 and now has over 30 partner organisations. It has spent over a year working in the province to improve health care services.
The Coalition met on 1 August 2014 to take stock of the state of the healthcare system and progress toward improvement. The key outcomes of the meeting were:
1. Unanimous agreement that the Eastern Cape Department of Health (ECDoH), including the new administration, the National Department of Health (NDoH) and other stakeholders have been given more than ample time to table and begin implementing a proper plan to address the crisis. We have not, however, seen adequate, and in many instances any, progress. Moreover, the ECDoH especially has largely failed to engage the Coalition and has not fulfilled its commitments to do so.
2. In light of the above, the Coalition unanimously agreed on the need to intensify our campaign urgently and significantly including by:
• Intensifying mobilization in communities, unions and churches;
• Demanding an urgent meeting with the provincial health department, MEC and premier;
• Demanding again that the department table and implement a proper plan to address the crisis; and
• If the above interventions do not result in urgent, sustained improvements in the healthcare system, the Coalition may be forced to pursue legal action to protect the rights, health and lives of people in the Eastern Cape.

The state of the health care system is causing loss of health and life on a large scale. We demand a plan to address this crisis. We have given the process and stakeholders more than enough time to show commitment to fixing this health system, but they have not produced results. Should urgent, sustained improvements not be forthcoming, the Coalition may be forced to turn to the courts to protect the rights and lives of people who rely on the health care system.

The purpose of ECHCAC has essentially been to mobilize communities and fix the provincial health system. ECHCAC has consistently been trying to engage the provincial government since July 2013.

On 13 September 2013, the Coalition held a march in Bisho and released "Death and Dying in the Eastern Cape" a report that told the stories of people who rely on the health system. On 19 September 2013, the national health minister called a press conference where he committed to a range of interventions, particularly in the OR Tambo National Health Insurance pilot district. At the provincial level, the then MEC Sicelo Gqobana refused to meet with representatives from the Coalition and opted to rather belittle the concerns of patients and healthcare workers.

In January 2014, the Coalition met with the new Superintendent-General Dr Thobile Mbengashe, who committed to a number of interventions and to working with the Coalition. Most of these commitments have not been fulfilled.
The Coalition's primary demand has been for the provincial and national department of health to develop and implement a plan to address the critical condition of the health care system. We have repeatedly called for a plan with timeframes, indicators and a budget.

The Eastern Cape health department eventually responded to this demand on 17 October 2013. It's five-page response contained vague descriptions of inadequate interventions. The Coalition provided the Department a detailed analysis of the plan and detailed guidance on what a proper plan would consist of. Almost ten months later, the department has not responded, despite multiple assurances to the Coalition that it would.

The ECHCAC met in January of this year and noted the lack of progress on the ground. We agreed that should urgent, sustained improvements not be forthcoming, litigation may be required. We also considered the 2014 elections and agreed to hold back litigation and rather intensify mobilisation in the hope that a new national and provincial government would take seriously and address the health crisis.

Shortly after his appointment, we received a positive letter from the Premier Phumulo Masualle. The Premier noted the need for a report from the MEC in regard to how the Coalition's concerns have been addressed. The Premier also requested that the MEC be given time to "put in place strategies and plans on how she will bring about quality health care in the Eastern Cape".

Over two months have now passed and we have not yet seen adequate "plans and strategies" from the MEC. In the meantime, people continue to suffer and die. It is time for action and results.

At last week's ECHCAC meeting, partners reported a range of serious and life-threatening problems, including for example:
• Continued drug and supply stock outs
o Ongoing challenges at the Mthatha drug depot with a shortage of staff
o Stock out of wheelchairs and crutches
o Ongoing challenges at Bedford Orthopaedic Hospital where they reportedly have a huge backlog on wheelchairs
o A six-month waiting list to access prosthetics for amputees
o A shortage of suction machines to collect and remove sputum in some areas
• A halt in rural rehabilitation outreach services due to an absence of transport
• A massive staff shortage including of nurses, doctors, EMS personnel, rehab staff and others. Commitments to fill vacant nursing posts have not been kept. The provincial department has failed to employ newly trained enrolled nursing assistants and nursing assistants despite the desperate need for them
• Staff with inadequate training leading to patients not adhering to their antiretroviral treatment
• A province-wide lack of ambulances and Emergency Medical Services with many areas having no access to ambulances whatsoever
• Shortages of staff, no water and regular electricity blackouts at Tafalofefe Hospital
• No direction or policy on the employment of community health workers
• A crumbling building at Hamburg Clinic, which was highlighted in the Death and Dying report after which the provincial health department visited the clinic and committed to fixing it
• Long waiting lists for mastectomies and surgical procedures post positive pap smears. ECHCAC members reported that patients were dying because surgery is often postponed indefinitely
• No masks and post exposure prophylaxis medication for Community Health Workers in some areas
• Continuing staff challenges and preventable baby deaths at Holy Cross Hospital. This hospital was featured in the Death and Dying report after Baby Ikho died due to a number of failures including a shortage of oxygen, a lack of equipment and delayed emergency transport. The National Department of Health committed to a range of interventions to fix this hospital yet it remains in a critical condition
• Ongoing delays in the commencement of building a new facility for Village Clinic in Lusikisiki, despite the provincial department being under a court order to provide the new facility
• Many clinics and hospitals continue to have no or irregular access to running water or electricity
• No proper plan to tackle continuing and rising circumcision deaths and injuries.

ECHCAC wants to work with the MEC and Premier to fix the Eastern Cape health system, we are willing to be their eyes and ears on the ground, to mobilise communities around priority programmes, to provide ideas on where and how the system can be fixed. But if they refuse a meaningful partnership, fail to be honest about the challenges and to make all plans public, then we have no option but to mobilise communities to fight for their rights. Members of ECHCAC feel enough is enough.

For further information:
Fikile Boyce, Treatment Action Campaign, Eastern Cape Provincial Chair: This email address is being protected from spambots. You need JavaScript enabled to view it. / 073 080 5379
Facebook: facebook.com/EChealthcrisis
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

The ECHCAC is a coalition of organisations and individuals primarily from the Eastern Cape dedicated to fixing the healthcare system and ensuring the realisation of the constitutional right to health in the Province.
The Eastern Cape Health Crisis Action Coalition includes:
• Association of Concerned Specialists of the PE Hospital Complex
• Black Sash
• Budget Expenditure Monitoring Forum
• Counsel for the Advancement of the South African Constitution
• Democracy from Below
• Democratic Nursing Organisation of South Africa
• Hospersa
• Igazi Foundation
• Jubilee
• Junior Doctors Association of South Africa
• Keiskamma Trust
• People's Health Movement
• People Living with Cancer
• Professional Association of Clinical Associates in South Africa
• Public Service Accountability Monitor
• Restless Development South Africa
• Rural Doctors Association of South Africa (RuDASA)
• Rural Health Advocacy Project
• Rural Rehabilitation South Africa
• Sonke Gender Justice
• South African Medical Association
• Treatment Action Campaign
• TB/HIV Care Association
• World Aids Campaign
• World Vision South Africa


Update 10 June 2014

Fikile Boyce is the new ECHCAC Coordinator

TAC and SECTION27 have successfully accessed funds to support a full time position for a Coordinator of the ECHCAC. Fikile Boyce, TAC Eastern Cape Provincial Chair, has been appointed in this full time position for one year.

He has been intimately involved in and critical to the formation and strengthening of the ECHCAC since the beginning.

While this follows closely on the heels of the loss of Kwazi Mbatha (below), these plans were in the works long before Kwazi's passing and the timing is only coincidental - people are not replaceable and Fikile's role, while overlapping with some of Kwazi's functions, is very different from Kwazi's role.

Fikile's responsibilities include organising and strengthening the Coalition, working closely with the legal team, organising communities, monitoring the health system, liaising with communities, patients, Coalition members, healthcare workers, government, the media and other stakeholders and generally driving the work of the Coalition.

(from Section 27 announcement)


Update 6 June 2014


The ECHCAC joins many in mourning the loss of Kwazi Emmanuel Mbatha. Kwazi passed away in the evening of Sunday 1 June 2014. Kwazi served as the spokesperson for the ECHCAC and was instrumental in its formation and strengthening. We are indebted to his work, vision, energy and kindness, all of which he brought to his work with the ECHCAC.

Kwazi joined the Rural Health Advocacy Project in 2013 and became an indispensable leader in the ECHCAC. Prior to his work with RHAP and the ECHCAC, Kwazi worked for the Centre for Economic Governance and AIDS in Africa as Researcher and Trainer. In that capacity, he worked closely with the Treatment Action Campaign.

We have lost a great activist, leader, colleague and friend. We join his partner and two children in mourning his death. Many have sent messages of mourning and remembrance in the past few days. Here are a few below:

• "We mourn this great loss of a wonderful person and loving father." - Marije Versteeg-Mojanaga, Rural Health
Advocacy Project, Director

• "We have lost a fighter and a great friend. This is very sad and painful. CEGA has benefitted from Kwazi's service since 2009, and the successes and Stories of Significant Change achieved in our joint CEGAA/TAC BMET Projects are due to his untiring efforts to promote transparency and accountability in the public sector. He will be greatly missed by all of us at CEGAA and our partners. May his wonderful soul rest in peace." - Nhlanhla Ndlovu, Centre for Economic Governance and AIDS in Africa, Acting Director

• "It is with shock and sadness to learn about the passing away of comrade Kwazi Mbatha, Kwazi was a gallant fighter, a human rights and social justice activist. Comrade Kwazi was a fearless fighter who stood firm in his conviction. Our sympathy and heartfelt condolences goes to his family, children and all those who worked with him." -Anele Yawa, Treatment Action Campaign, National Chair

• "Kwazi was a good colleague, a comrade and a friend. He was instrumental in setting up and strengthening ECHCAC. He was liked and respected by RHAP, TAC, SECTION27 and others. He was young and alive to life." -John Stephens, SECTION27, Legal Researcher

• "Kwazi was an activist at heart and willingly fought for what's rightfully his and on others' behalf. Condolences to his family and children. Hamba Kahle Nkokheli." -Nombasa Gxuluwe, World AIDS Campaign

• "It is with great sadness that the Black Sash acknowledges the passing of Kwazi Mbatha, a wonderful person and dedicated human rights activist. We send our deepest condolences to his family and loved ones – they are in our thoughts and prayers during this difficult time. May his dear soul rest in peace." Alexa Lane, Black Sash Trust, Regional Manager

• "On behalf of RURESA, I want to echo the other messages. Condolences to Kwazi's family. He will be missed. I found him an amazingly energetic and inspiring man, who did his work with so much persistence and thoroughness. I feel honoured to have worked in the Coalition with him." -Karen Galloway, Rural Rehab South Africa

• "Deepest sympathies and condolences to the family of Kwazi Mbatha from the Association of Concerned Specialists of the PE Health Complex." - Dr Basil Brown, Association of Concerned Specialists of the PE Health Complex

• "We at CASAC are saddened to learn of the passing away of Kwazi Mbatha. We convey our condolences to his family, friends and colleagues. We will continue his work to create a society in which the rights and dignity of all people is respected. Hamba Kahle Qabane." - Lawson Naidoo, Council for the Advancement of the South African Constitution, Executive Secretary

• "On behalf of Eastern Cape Treatment Action Campaign office, this so sad, we have worked with Kwazi since 2009, he was an activist, a fighter – known by the whole province of the DoH and the TAC branches at large. We have learned a lot from him, condolences to his family, may his soul rest in peace." - Noloyiso Ntamenthlo, Treatment Action Campaign, Eastern Cape OR Tambo District Organizer

• "On behalf of PHMSA in the Eastern Cape, we would like to convey our deepest condolences to the Mbatha family and his loved ones in this hard time. His work within Eastern Cape on the struggle for health has been noticed and with his vision, we will keep the momentum going." - Lulamile Timbiliti, People's Health Movement South Africa

• "Akwehlanga lungehliyo, Ziyofa izinsizwa zosala izibongo. It is sad news indeed and it is a great loss for all of us.
Sekudala uzabalaza ulale ngoxolo Bhuti." -Patrick Mdletshe, SECTION27, Researcher

Flowers can be sent to: 128 De Waal Place, Southlands Pietermaritzburg, 3201


Press Statement: Eastern Cape Health Crisis Action Coalition Calls for Decisive and Urgent Action by Government and Traditional Leadership to Stop Annual Avoidable Circumcision Deaths and Mutilations - 31 January 2014

A recently launched website unveiling the secrecy around the annual initiation rituals in the Eastern Cape has sparked a large outcry among sections of the Eastern Cape population, notably the Traditional Leadership. The website was launched by a health care provider after treating mutilated boys across several initiation seasons and failed attempts to work with the traditional leadership in finding solutions.


Update 13 November 2013

Eastern Cape Health Crisis Action Coalition: Volume 2 contains the Coalition's analysis of the ECDoH "plan" to fix healthcare in the Province, which we provided to the MEC on 5 November. We hope this format lends itself to distribution. This document will be an important reference point going forward.

Read more... (pdf 2.5MB)

Update 5 November 2013

Eastern Cape Health Crisis Action Coalition: Response to Eastern Cape Department of Health “Eastern Cape Health Systems Interventions

Read more... (pdf)


CAPE TOWN - National health minister Dr Aaron Motsoaledi and newly appointed Head of the Eastern Cape health department Dr Thobile Mbengashe today addressed the Portfolio Committee on Health regarding plans to address the crisis in the province.


Update: Coalition awaits answers from Health MEC - 16 October

The Eastern Cape Health Crisis Action Coalition is disillusioned by the lack of response from health MEC, Sicelo Gqobana, following a range of issues it raised.

Read more... 

Press conference: Deadline looms for Eastern Cape Health MEC Sicelo Gqobana

On September 13 2013 the Eastern Cape Health Crisis Action Coalition (ECHCAC) handed a memorandum to Eastern Cape head of department Thobile Mbengashe. In it we raised a number of issues in which we requested Eastern Cape health MEC Sicelo Gqobana to respond with a detailed turn-around plan for the province’s health system by October 11.


Eastern Cape Health Crisis Action Coalition
Update: Volume 1. 4 October 2013

This is the first in a series of updates from the Eastern Cape Health Crisis Action Coalition, a
Coalition of organisations and individuals dedicated to fixing the healthcare system and
ensuring that the constitutional right to health is fulfiled in the Eastern Cape. Please contact us
through the means provided below to get involved. Click here to download Eastern Cape Health Crisis Action Coalition Update: Volume 1 

Email: This email address is being protected from spambots. You need JavaScript enabled to view it. Web: www.echealthcrisis.org Facebook: www.facebook.com/EChealthcrisis


Baby Ikho Campaign

Baby Ikho died on 20 August 2013 when oxyen supplies ran out at Holycross Hospital in Flagstaff, Eastern Cape. He was failed on multiple levels by a provincial health system in crisis.

His story was part of a major expose’ of the breakdown of the health system detailed in a report by Section 27 and TAC that was launched on 11 September 2013. 

Baby Ikho’s death has become a rallying point for a range of organisations, which will be marching to Bisho on Friday, 13 September, under the banner of the Eastern Cape Health Crisis Action Coalition, to demand that the province urgently addresses the healthcare crisis.

The Black Sash believes in the Right to Health which is enshrined in Section 27 in the Bill of Rights of our constitution.


Black Sash Media Statement on joining the Eastern Cape Health Crisis Coalition

The special SECTION27 and TAC investigative report into the collapsing health system in the Cape is a wake-up call to all concerned about the constitutional right to health and human rights.

The Black Sash commends the report for presenting us all with the human face of persistently appalling health statistics in the Eastern Cape. In the context of unacceptably high mortality and morbidity statistics, as well as poor and often non-existent interventions, it was vital that a report of this kind make visible “the people and their pictures.” We know that it is a mere glimpse of the thousands of stories that the more than 6 million people can tell about the failure of the health system in this province. Read more...