More than a year after their finalisation and after many frustrated attempts by civil society organisations and the media to access them - including through the Promotion of Access to Information Act, 2000 - SECTION27 and the Rural Health Advocacy Project (RHAP) have finally been leaked copies of all the provincial reports compiled by the Integrated Support Teams (ISTs). Up to this point, the only report we have received officially is a consolidated report available here. This report is important, but l acks the necessary detail to allow civil society to engage with different challenges in different provinces.
The IST reports on each province were commissioned by the former Minister of Health, Barbara Hogan, in response to the massive budgetary shortfalls that over-whelmed provincial departments of health (PDoHs) in the 2008/2009 financial year, which reached crisis levels when the Free State Department of Health issued a moratorium on the initiation of new patients onto antiretroviral treatment in November 2008. After civil society pressure, that moratorium was finally lifted in February 2009.
The IST reports contain an honest, sobering assessment of the inadequate financial capacity of provincial departments of health that have led to the development of over R7.5 billion in provincial debt as of April 2009. The findings in these reports reveal fundamental failures in political and bureaucratic leadership, inappropriate financial management systems, inadequate monitoring and evaluation systems, and a failure to plan appropriately for human resources, amongst others.
The reports also contain detailed recommendations of what steps must be taken to resolve these systemic failings and assign responsibility to implement the recommendations to the Minister of Health, the National Department of Health (NDoH), the PDoHs, National Treasury, provincial treasuries, the Department of Public Service and Administration and external stakeholders. These recommendations - if implemented - will go far towards developing a public health care system capable of achieving the right to have access to health care services guaranteed in section 27 of the Constitution.
This process, however, requires leadership from the Minister of Health, Dr Aaron Motsoaledi, and the Director-General of Health (DG), Ms Precious Matsoso. The DG already indicated a commitment in this regard when she stated to the Select Committee on Public Accounts in Parliament on 3 August 2010 that:
The basis of our analysis is based on diagnostic work that was done - I refer to the IST reports. As you know much analytical work that is done ... that reports are produced and nothing happens. So what we have done, where there were clear recommendations of what the problem is and what the solution should be and we used that as the basis for coming up with a plan.