The fourth service of the SA National Defence Force (SANDF) was in the Parliamentary spotlight this week and will be again in the not-too-distant future to “engage on the wide range of challenges” facing the SA Military Health Service (SAMHS), including its R2 billion budget shortfall.
Deputy Surgeon General, Major General Noel Ndhlovu, gave the Portfolio Committee on Defence and Military Veterans (PCDMV) insight into the military health system and its planning for the medium term expenditure period. He was also due to inform the committee of the maintenance and repair programme for military hospitals and sickbays.
This did not form part of the two-star general’s presentation with the committee told “Log Division (the logistics arm of national defence force) is the process owner of repair and maintenance of SANDF facilities including hospitals and sickbays” and “detailed information to be provided at a later stage by Log Division”.
According to PCDMV chair Cyril Xaba there is “concern” about a R2 billion shortfall in the military medical budget. He said availability of resources was threatening the quality of health services provided to military personnel and a common perception of poor service “resonates among not only SAMHS patients but also the SANDF Command Cadre”.
SAMHS faces a projected budget shortfall of R2.2 billion for 2020/21 and R2 billion in 2021/22. There will be a shortfall of R2.1 billion in 2022/23. SAMHS budget allocation has not aligned with increased health costs and a lack of funding makes it difficult to maintain medical stock levels.
“SAMHS performance was satisfactory despite the financial risk. It must be highlighted the unique situation facing SAMHS, that of a continuous increase in its footprint resulting in increased demand for healthcare services, will impact negatively on budget and service delivery,” Ndhlovu stated in his presentation.
“SAMHS continues to render healthcare services amid strategic risks. Delivery of a comprehensive healthcare service is negatively affected by the budget allocation for SAMHS. Compulsory budget baseline reductions over the three financial years from FY2020/21 to 2022/23 will exacerbate the insufficient budget allocation risk. The strategic risks of SAMHS impacta on all objectives and outputs across the five sub-programmes of the service. Challenges and strategic risks exacerbate operational readiness and sustainment of healthcare service delivery.”
Another “challenge” is recruitment, appointment and retention of uniformed healthcare professionals and critical support personnel. Defence and Military Veterans Minister Nosiviwe Mapisa-Nqakula, according to a Parliamentary Communication Service statement, told the PCDMV a task team was investigating why “many medical personnel opt to move from SAMHS to the Department of Health”.
The committee heard doctors and specialists are often frustrated by a lack of equipment and budget which hampers them when at work.
Ndlovu told the committee many challenges emanate from SAMHS delivery model; human resource balance and management; distribution of healthcare facilities; sub-optimal supply chain management; an inadequate healthcare monitoring system and tools as well as continuous budgetary constraints.
Xaba said issues affecting SAMHS are “far-reaching and severe” at the same time acknowledging the efforts of current leadership in “addressing challenges”.
The PCDMV needs, according to Xaba, “needs a thorough briefing on what has been achieved to date and plans to mitigate long-term challenges faced by SAMHS”.
SAMHS has a patient population of 176 483, including 61 218 regular force members, 71 884 regular force dependents, 28 028 reserve force members and 17 457 military veterans and dependents.
In the past decade, SAMHS experienced a perceived decline in the quality and responsiveness (to patients’ expectations) of its healthcare services as well as a quantifiable escalation in the cost of healthcare service delivery.
“The perception is endemic among SAMHS patients and to an extent, among the Command Cadre of the SANDF. The challenge manifests as sub-optimal HR productivity; sub-optimal operating and capital budget ratios; escalating medico-legal claims and expenditure; patient dissatisfaction with the profile of the SAMHS facilities; patient complains about service delivery standards; and SAMHS inability to optimally protect, promote, improve, and maintain the health of the military community.”