By Chris Bateman

A combination of Eskom power outages and BEE-impacted procurement rules is putting patients in deep rural hospitals at heightened risk as managers struggle to secure reliable diesel supplies and maintain back-up generators.

The related diesel cost to a single district hospital can reach R1 million annually.

One rural Eastern Cape district hospital was without Eskom power for an average of 127 hours each month from September last year to February this year, improving to 60 hours per month in March and April this year, (the longest continuous outage being 48 hours), costing management an average of R120 000 per month for an erratic supply of diesel to run two large back-up generators.

Madwaleni Hospital is on the East Coast, about 100km from Mthatha.

Its acting CEO and medical manager, Dr Andrew Miller told MedBrief Africa, “We haven’t lost any patients, but it’s stressful. The staff really feel it. It’s a full-time job to keep reporting to Eskom, making sure there’s enough diesel and keeping our generators maintained. We have no control over the Eskom outages, and we don’t know where the problem is. Often, it’s with local sub stations, but it can be 24 hours before a technician gets on site, while communication is a real problem.”

Two valleys across from him as the crow flies, Zithulelele District Hospital operates in relative normality, mostly unaffected by Eskom’s load shedding.

Doctors become diesel mechanics

Miller says that although the provincial health department “did really well to spend capital on our generators,” his doctors have become amateur diesel mechanics owing to generator breakdowns – even though their off-site repair contractor is ‘reliable and responsive.’

“It’s difficult to get parts. We’ve replaced three starter motors and an alternator so far. From a patient care perspective, we pump and process our own water which obviously stops with power outages. The cellphone networks also go down, so the on-call doctor cannot be contacted easily by nurses after hours.”

“It’s very stressful keeping a maternity ward running (for example). You can’t just transfer all the patients to Mthatha – that takes two hours at least. Fortunately, we’ve done no C-sections by candlelight!”

When interviewed, Miller had 16 pregnant patients in his maternity ward.

“Our stakes are higher than in the city – you can imagine the logistics of transferring that many patients over rough dirt roads,” he added.

He said that unless the on-call doctor contacted Eskom immediately, the outage was only reported in the morning, resulting in extended delays.

“I suspect the maintenance of generators is costing the province more than the diesel itself – it must be impacting on their overall budget – our top annual budget for diesel alone is R985 000 per annum,” he revealed.

He said summer thunderstorms sometimes also triggered outages.

 Tender changes complicating diesel procurement

Miller confirmed that diesel procurement was complicated by a national treasury ‘tender exception’ protocol change, forcing affected hospitals to procure ‘out of contract’ using three quotes of R30 000 or less each, instead of using bulk suppliers.

“We have sufficient budget, but it’s ridiculous that it needs to be so much. The problem is that Treasury has an RT70 contract for the procurement of diesel and fuel for all hospitals in the country. Unfortunately, the suppliers they’ve chosen have not been able to hold up their side of the contract” he said.

“Our previous suppliers were reliable and regular, whereas these newly contracted companies don’t always have the vehicles and local contacts to deliver to rural hospitals like ours,” he said.

So far Madwaleni had not run out of diesel, “but we’ve come close,” he added.

Dr Lungile Hobe, Clinical Manager at Mseleni District Hospital near Sodwana Bay and Chairperson of the Rural Doctors Association of South Africa, (RUDASA), said Eskom outages and damaging power surges were the bane of rural hospitals.

Power surges damage hospital equipment

Besides her suffering sleepless nights worrying about diesel supplies running out, a new aircon in her hospital operating theatre was not linked to the generator, meaning no elective procedures could be done, sometimes for a up to six hours a day. Power surges had damaged their anaesthesia machine, ultrasound machines, a ventilator in High Care and some ECG machines. Hospital vehicles were regularly dispatched to clinics to empty fridges of vital medicines and vaccines and return them to the hospital for cold storage. Cellphones and vital apps like the Vula App (used for much-needed expert medical advice and patient care), were unusable, meaning patient treatment emergencies often became mini crises.

Hobe said one block of doctors living at Mseleni was also not connected to the generator set and regularly suffered thousands of rands of losses in spoiled foods, having to make a 390 km round trip to Richards Bay for a fortnight’s shopping.

Another rural clinical manager who declined to be named for fear of victimisation, said he recently had to give somebody R2 000 in cash to drive out and buy diesel after their generator ran empty – just to get through the day.

“Otherwise, you need to get three quotes, advertise and wait for objections – it takes up to a week for authorisation for the diesel purchase,” he scoffed.

Only this one hospital in a severely budget constrained KwaZulu Natal, where a moratorium prohibits the hiring of all ‘non-essential staff,” confirmed running out of diesel. Another, Mosvold Hospital near Ingwavuma on the KZN North coast, also reportedly ran out.

However, the Clinical Manager there, Dr Henni Hamilton said he’d just returned from leave, and could thus not confirm the diesel supply failure. He responded, “also, I’m not allowed to discuss this.”

It proved a recurrent theme nation-wide, except for the Western Cape where there have been no officially reported diesel-related or maintenance-related generator failures.

Concourt rejects BEE procurement regulations

In mid-February this year the Constitutional Court struck down an appeal supporting an earlier High Court ruling allowing an amendment to the BEE’s preferential procurement rules which increased mandatory black ownership of service and product provider companies from 20% to 100%. National Treasury issued an ‘advisory’ to all provinces to freeze all tenders from February 16th onwards but allowing an ‘exceptions’ rule for tenders. This created a heavy bureaucratic load as provincial health (and other) departments scurried to take legal advice and/or create multiple tenders where far fewer tenders were previously needed.

Treasury is currently appealing the ruling.

In a recent National Health Department webinar updating the national Covid infections surge, Deputy Director General in the National Health Department, Dr Nicholas Crisp, told MedBrief Africa that the Constitution Court BEE ruling had not affected the vaccination programme.

His Director General Dr Sandile Buthelezi added, “The ruling was not retrospective, so none of the vaccine contract requirements were affected in any way. There is however a system in place where we work with the Procurement Office for emergency measures.”

Despite Treasury’s assurance that the circular was “merely advisory”, municipal governments in Cape Town and Johannesburg said it placed them in a difficult, confused position.

In Cape Town, tenders to the value of hundreds of millions were affected. The city’s mayor, Geordin Hill-Lewis, was quoted as saying the metropole had hoped to conclude a tender for essential medical equipment by 22 March. It included new blood pressure monitors, blood glucose sensors, stethoscopes, and other medical devices for the city’s clinics. Another example of a vital tender affected was one for weatherproof jackets and fire-retardant clothing for the city’s firefighters. Johannesburg spokesperson Nthatisi Modingoane said tenders of R1.3 billion were affected.

He warned that Treasury’s tentative embargo would have a massive impact on service delivery, the city’s annual procurement plan, and their integrated development plan goals.

Hill-Lewis and Modingoane also warned that various contracts normally renewed monthly would eventually need to be cancelled if Treasury’s moratorium dragged on. Western Cape, provincial finance minister David Maynier said his interpretation of the Treasury circular was that it immediately halted 86 tenders to the value of R1.85 billion planned for March 2022.

Limpopo, Health MEC, Dr Pophi Ramathuba, said 12 major contracts were immediately impacted with a wide range of medical equipment involved costing “tens of millions.”

A spokesman for National Treasury told MedBrief Africa that organs of state had to exercise a choice on how to proceed with procurement. This involved ‘deciding on whether to take the position that the suspension of the invalidity still continued or whether to apply for an exemption in terms of (Sec 3C) of the Preferential Procurement Policy Framework.’

A MedBrief Africa assertion to National Treasury that leaving it up to individual organs of state to make a choice on the validity/invalidity of the Concourt ruling smacked of ‘passing the legal buck,’ remained unanswered at the time of publication.

A recent data analysis of the all-important EAF (energy availability factor (EAF) for Eskom’s generating fleet for 2022 so far shows it standing at 58.64%, compared to 61.79% for 2021. By May 9th Eskom had reached 50% of the total days of load shedding implemented in 2021. This bodes ill for rural patients’ care with nation-wide winter demand yet to kick in.