Funding shortfall means military health patients face complications and possibly death

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A presentation by the Director: Military Health Planning of the SA Military Health Service (SAMHS) left Parliament’s Joint Standing Committee on Defence (JSCD) under no illusions about the poor health of the national defence force’s healthcare facilities.

Brigadier General Modikana Langa last week told the oversight committee R2.707 billion is needed to improve the capacity and capability of the three military hospitals in its portfolio: 1 Mil in Thaba Tshwane, 2 Mil in Wynberg, Cape Town, and 3 Mil in Bloemfontein’s Tempe. This would involve R1.5 billion annually for human resources and a R1.182 billion once-off capital injection. The latter would cover ambulances, digital infrastructure, medical equipment, digitisation of records and improved security systems.

The major challenge facing the SAMHS in fulfilling its mandate of providing healthcare services to the SANDF and its members is limited resources, according to Langa.

Langa’s presentation revealed a requirement at the three military hospitals and five sickbays of 1 631 personnel at a cost of R721 million. Disciplines include medical specialists; nursing, medical and dental officers; healthcare and support personnel.

The SAMHS  has an approved structure of 10 748 personnel, with National Treasury approved funding for 6 612 as part of efforts to reduce the SANDF human resources bill. This results in costly outsourcing. Fully funding the SAMHS would cost R9.6 billion a year while the actual allocated budget is R5.5 billion. This R4.5 billion underfunding does not take into account inflation, population growth and more SANDF operations. These affect day-to-day unit combat readiness, quality of patient care, acquisition and retention of scarce skills, equipment and facility refurbishment.

Langa listed eight key requirements to optimise military healthcare. They are acquisition and retention of HCPs (healthcare professionals); upgrading military health facilities; bringing pharmaceutical stocks to a required level; establishing in-house capabilities for workshops/factotums to concentrate on medical facilities and equipment; medical equipment; “contemporary” and digital technology; electronic security surveillance systems as well as electronic and virtual learning.

On military medical facilities, Langa told parliamentarians a “protracted infrastructure programme” worsens SAMHS’ financial situation pointing “especially” to the ongoing refurbishment and upgrade of 1 Military Hospital. Other facilities he named were base hospitals at Air Force Base (AFB) Hoedspruit in Limpopo and the SA Army Combat Training Centre (CTC) at Lohathla in the Northern Cape as requiring significant repairs and maintenance.

If not attended to, SAMHS could lose accreditation with bodies such as the national Department of Health and the Health and Health Professions Council of South Africa (HPCSA). Other concerns are the possible loss of junior HCPs as well as “a direct impact” on job satisfaction, standard of care, skills retention and on-the-job training. He pointed out SAMHS has “already lost specialists due to medical facilities and equipment not complying to laid down standards.

He was the bearer of further bad tidings as regards medical equipment with what he termed “ageing main medical equipment (MME)” taking centre stage. It “requires constant repairs and servicing” with repair and calibration taking too long due to spares unavailability. In turn this means long waiting times and delays for patients requiring specialist medical intervention with patients “potentially exposed to complications and even loss of life”.

The SAMHS is mandated to provide a health support capability of five medical battalion groups, including accompanying field hospitals and a specialist medical battalion group for deployed and contingency forces (Joint Force Employment Capabilities). The second SAMHS output according to Langa is to ensure a comprehensive multidisciplinary military health service for a projected patient population of 302 000 people a year, including military veterans and VVIPs by way of the Presidential Medical Unit (PMU).

Challenges the SAMHS faces in delivering on its mandate include an ageing military population requiring more support; reimbursement issues with the Department of Military Veterans (DMV) affecting veterans’ healthcare and the loss of millions of Rand annually due to medical malpractice/negligence claims  driven by the quality of healthcare services and clinical errors. “Money spent on these claims is money that could be spent on essential healthcare priorities,” the presentation noted.

Langa’s presentation was not all bad. Highlights over the last year include supporting the National Department of Health during strikes in March at hospitals in North West, Gauteng and KwaZulu-Natal; providing healthcare services to the public in February as part of Armed Forces Day (Project Owethu) as well as healthcare services to rural KwaZulu-Natal residents during Exercise Shared Accord 2022 in June and July.