QUESTION ONE [25] Read the following and answer the question that follows: Delivery of quality health care is a constitutional obligation in South Africa. Government has therefore introduced numerous developments and programmes to improve health care, efficiency, safety and quality of delivery and access for all users, and there have been major changes in health policy and legislation to ensure compliance in delivering quality care. Despite a number of commendable goals having been set by government for improved quality of service delivery in healthcare settings, reports by media and communities in 2009 revealed that services in public health institutions were nonetheless failing to meet basic standards of care and patient expectations. This has caused the public to lose trust in the healthcare system. The healthcare system in South Africa as ruined and in serious need of repair. Many of problems in the South African healthcare system can be traced back to the apartheid period (1948-1993) in which the healthcare system was highly fragmented, with discriminatory effect, between four different racial groups (black, mixed race, Indian and white). To worsen the situation, the apartheid government developed 10 Bantustans (the so-called ethnic homelands) into which Africans were unwillingly segregated, and each of which had their own departments of health with their professional bodies. This led to deterioration in health system delivery because of lack of resources, and poor communities were especially affected. Huge efforts have been made to improve the quality of healthcare delivery in South Africa since 1994 elections, but several issues have been raised by the public regarding public institutions. Among the many, the following seven issues are discussed in this article: prolonged waiting time because of shortage of human resources, adverse events, poor hygiene and poor infection control measures, increased litigation because of avoidable errors, shortage of resources in medicine and equipment and poor record-keeping. Prolonged waiting time because of shortage of human resources A major weakness in sub-Saharan African health systems is inadequate human resources. Africa is said to have less than one health worker per 1000 population compared to 10 per 1000 in Europe. Health problems in South Africa are worsened by unequal distribution of health professionals between the private and public sectors, coupled with unequal distribution of public sector health professionals among the provinces. In a study conducted by Tana (2013:82), participants affirmed the insufficiency and inadequacy of health workers which they described as leading to physical and mental exhaustion, and in some cases to further deterioration of their medical condition. Adverse events Other incidents reported were patients who developed complications, and in some cases died, because they were turned away from the public healthcare facility or denied access to healthcare service. The Sunday Tribune (08 March 2015:2) reported on the family of a 35-year-old woman that blamed tertiary hospital staff in KwaZulu-Natal for her death after she was allegedly turned away from the hospital despite being gravely ill. Kama (2017:2) reported the case of a 1-year-old baby who died on his grandmother's back after they were turned away from three different healthcare facilities in one of the townships in Cape Town. In another incident in the same township, a teenager gave birth on the pavement outside the gates of a health facility because she was not allowed access (Kama 2017:2) Poor hygiene and poor infection control measures According to Young (2016:20), public healthcare facilities exhibit numerous shortcomings such as long waiting times, poor-quality healthcare delivery, old and poorly maintained infrastructure, and poor disease control and prevention practices. According to Dunjwa (2016:1) and the South African Medical Association (2015:36), most facilities had problems such as poor waste management, lack of cleanliness and poor maintenance of grounds and equipment. In a study by Nevhutalu (2016:138), patients and staff confirmed that some departments had an unacceptable physical environment (e.g. dirty toilets) for delivery of quality health care. Increased litigation because of avoidable errors There has been a proliferation of medical negligence litigation against the Department of Health, leading to large payouts which have put further strain on the health budget. At a medico-legal summit in Pretoria (09-10 March 2015), Health Minister Dr Aaron Motsoaledi described these claims as reaching 'crisis' level: 'The nature of the crisis is that our country is experiencing a very sharp increase - actually an explosion in medical malpractice litigation - which is not in keeping with generally known trends of negligence or malpractice' (Kollapen et al. 2017:3). In a report indicating medico-legal claims paid by government in each province in South Africa (presented at the summit by the acting Chief Litigation Officer of the Department of Justice and Constitutional Development), the total amount paid out for litigation in 2015 was R498 964 916.72; the Department of Health in KwaZulu-Natal led with total claims paid amounting to R153 612 355.49 and with over 5 billion rand in pending claims against the province (Kollapen et al. 2017:16). The South Africa Nursing Council likewise reported a rise in misconduct cases against nurses, which indicates that the rights of both patients and families were violated (National Department of Health 2013:38). Kukreja, Dodwad and Kukreja (2012:11) further verified the incidence of malpractice litigation claims involving the nursing community, although there have not as yet been any scientific studies conducted in South Africa concerning the nursing community. Shortage of resources in medicine and equipment TimesLIVE (14 June 2018) reported concerns raised by some members of the public regarding the shortage of equipment in hospitals that leads to fatal delays in urgent surgery. Work backlog causes extended delay for some patients awaiting treatment, such as cancer patients who are affected by the lack of oncology doctors and of equipment, and long waiting lists for surgery or diagnosis, also because of the lack of equipment. According to the report, the long waiting times for medical intervention potentially exposed patients to development of complications or even loss of life; public hospitals, in the words of the report, have become 'a death-trap for the poor' (TimesLIVE 2018:5). A study by Mokoena (2017:67) revealed about the lack of material resources, equipment and supplies (e.g. glucometers for monitoring blood glucose and needles for lumbar puncture in investigating or diagnosing meningitis), resulting in prolonged patient stay in the hospital. Participants also mentioned that the scan machine was not in proper condition, and that patients were therefore referred to other hospitals for investigations or they had to wait until the machine was fixed, resulting in delayed diagnosis and treatment (Mokoena 2017). Manyisa and Van Aswegen (2017:36) reported that the lack of administrative equipment and skilled professionals adversely affects the quality of care offered in health institutions. Poor record-keeping Kama (2017:80) points out that poor record-keeping causes unnecessary delays for patients. Sometimes, patients' folders are missing or lost, and instead of healthcare workers explaining this to the patient, they simply let the patient wait (Kama 2017:80). In worst scenarios, the medical history of the patient is lost, which can create further complications leading to incorrect diagnosis and in some cases death of the patient (Kama 2017:80). As reported by the Mercury (09 April 2015), the Pietermaritzburg High Court ordered a district hospital in KwaZulu-Natal to hand over medical records to the patient's attorney in a case where the patient had in July 2006 delivered twins in the hospital, allegedly losing one of the twins while the surviving twin suffered from cerebral palsy because of hospital neglect (Regchand 2015:2). (Source: Maphumulo W. and Bhengu B (2019). Challenges of quality improvement in the healthcare of South Africa post-apartheid: A critical review. Curationis, 42(1), doi:https://doi.org/10.4102/curationis. v42i1.1901)

Analyse the how poor health outcomes are attributed to the healthcare system despite transformation post-apartheid and efforts made to improve the quality of healthcare delivery in south africa