Eastern Cape health department is breaking the law in the way it runs Dora Nginza Hospital – Public Protector

Public Protector Advocate Kholeka Gcaleka. (Photo: Gallo Images / Papi Morake)

1 Jun 2025

In a damning and scathing report the Public Protector has found that the Eastern Cape Department of Health is breaking a handful of laws and regulations in its management of the Dora Nginza Hospital.

The Eastern Cape Department of Health has been called out for breaking several of the country’s health laws and regulations and violating the Constitution in the way it runs Dora Nginza Hospital in Zwide, Gqeberha. This follows an earlier, unannounced visit to the hospital by the Public Protector, Advocate Kholeka Gcaleka.

While the right of access to health is enshrined in the Constitution, government departments are allowed to claim they do not have the budget to implement all measures immediately. However, the Public Protector found that the department failed to use funds allocated for essential equipment.

It is well-known to hospital staff that prior to an inspection, an “advance team” is usually sent to state hospitals in the province to make sure they are clean, equipment is working and overcrowding is under control, but this time Gcaleka did not inform the department’s head office in Bhisho of her visit.

During the visit in 2024, the Public Protector identified numerous operational shortcomings. These included an insufficient number of security personnel on site and a defective closed-circuit television system. In addition, security protocols for maternity wards – including ID verification and visitor passes – were not properly implemented.

Damning report

Public Protector Advocate Kholeka Gcaleka. (Photo: Gallo Images / Papi Morake)

Although the Public Protector visited the hospital in 2024, her report was released just days after two newborns were stolen from Dora Nginza Hospital’s maternity ward in May. A 26-year-old woman, Sinovuyo Rabula, appeared in court on Friday, 30 May. Her bail application was postponed to 6 June.

Read more: Stolen Dora Nginza Hospital babies found safe, but questions remain about safety measures at hospital

Key findings from the Public Protector’s investigation include:

A critical shortage of staff is negatively affecting healthcare delivery. The hospital is still operating on a 2016 organogram, which has become obsolete, especially considering the additional tertiary services it now provides.

The centralised recruitment process at the provincial Department of Health office significantly delays the hiring of both clinical and non-clinical staff.

The maternity ward is overcrowded, with some women who have given birth forced to wait on chairs for available beds – a situation that increases their risk of infection and other complications; and

There is no privacy during patient consultations.

Daily Maverick has been highlighting the crisis in state hospitals in Nelson Mandela Bay for years, including warnings about the unprecedented scale of resignations of doctors from these facilities.

Read more: Eastern Cape’s Dora Nginza Hospital besieged by a rat infestation

The Public Protector echoed what health leaders and civil society groups have been saying for the past 15 years: the absence of a district hospital in the Nelson Mandela Bay District has placed immense strain on Dora Nginza Hospital. The facility is forced to serve simultaneously as a clinic, district hospital, regional hospital and tertiary centre – particularly for obstetrics, gynaecology and paediatrics.

The neglect of this key hospital in Nelson Mandela Bay — which provides specialist services to the entire western region of the province — was further underscored in the latest health statistics published in the District Health Barometer in April.

Nelson Mandela Bay was identified as one of the worst-performing districts in the country, recording the second-highest number of maternal deaths (35) in the province – an increase of seven from the previous year. The statistics also show that both neonatal and early neonatal death rates at health facilities in the metro have risen year on year, placing the district among the country’s poorest performers in this category as well.

The report further highlighted the shortage of medical equipment such as blood pressure machines, haemoglobin machines, cardiotocography machines, Dinamaps (patient monitors) in the postnatal ward and infant warmers.

Investigators found that the department failed to spend the allocated budget for equipment.

“The low level of spending while there is a shortage of critical medical equipment suggests that there is a serious structural problem in the Eastern Cape Department of Health, which renders the provision of basic healthcare services less reliable or not delivered in a progressive and effective manner as contemplated in the Constitution and the law,” Gcaleka said.

She ordered national Minister of Health, Dr Aaron Motsoaledi, to “take cognisance of the report and ensure that the remedial action is implemented”.

Eastern Cape Premier Oscar Mabuyane was also instructed to “ensure executive oversight so that the remedial action by the Public Protector is implemented”,

The head of the Eastern Cape Department of Health, Dr Rolene Wagner, was ordered to submit a detailed plan – with timelines – to address critical issues. These include:

Improving hospital security;

Implementing a plan within four months to convert Empilweni TB Hospital into a district hospital;

Addressing severe staff shortages (medical and non-clinical);

Relocating Dora Nginza’s kitchen and laundry;

Finalising recruitment for non-clinical vacancies;

Procuring new trolleys and specialised cooking equipment and disposing of the defective ones; and

Completing and submitting a finalised organogram

At the time of the Public Protector’s visit in 2024, Wagner was not in control of the department as she had been moved to the Office of the Premier in October 2023 to form part of his “crack” team to solve the pressing problems in the province. She only returned to her job in August 2024.

Other findings included that the province’s health department was not delivering healthcare services in a “progressive and effective manner” as contemplated by the Constitution; that treatment of patients, especially of pregnant women, at the hospital “may be a violation of the national health regulations, which places an obligation on the functionaries of the hospital to maintain an environment which minimises the risk of disease outbreaks, the transmission of infection to other users, healthcare personnel and visitors.”

The ongoing shortage of midwives and delays in filling vacant posts since 2017 – along with a lack of nurses in the postnatal ward to manage patient overflow during peak periods – continues to place a heavy burden on the hospital's limited staff and their mental wellbeing, the report noted.

“The delay in implementing intervention measures such as the establishment of a level 1 maternity service at [the] Port Elizabeth provincial hospital, which should have been done in March 2023, and the conversion of Empilweni Tuberculosis Hospital to a district hospital which would also offer level 1 maternity services has negatively impacted the delivery of antenatal and postnatal services at the hospital,” it said.

Read more: Twenty-nine pregnant women evacuated from overwhelmed hospital in Nelson Mandela Bay

Investigators also found that the outdated 2016 organogram had led to severe staff shortages in key departments, including the kitchen, laundry, theatres, maintenance, surgical units and casualty wards.

Other findings include that 30 cardiotocography machines that were ordered in January 2023 had not been delivered. Only one infant warmer was working during the inspection.

“Despite regulation 13(1) of the National Health Act (NHA), placing an obligation on the hospital to ensure that the medical equipment is available and functional in compliance with the law, the functionaries of the facility and the head of Department for Health in the Eastern Cape have failed to ensure that the hospital has essential equipment in all clinical service areas,” Gcaleka said in her report.

“The undue delay in the procurement of medical equipment has [the] potential of endangering and compromising the lives of people who depend on the hospital for healthcare. The responsibility of ensuring that timeous procurement of adequate medical equipment is delivered to the hospital is the responsibility of the department to safeguard the health and safety of all workers and patients,” the report said.

The hospital reportedly has only two washing machines, one of which was broken — meaning that its laundry had to be done at Livingstone Hospital.

“This is not sustainable,” the report said, adding that the issue should be speedily resolved to “mitigate the risk of patients contracting infections and address the serious impact on the operations of the hospital. This negatively affected the availability of linen for the wards, to the extent that the linen provided to the patients was not properly cleaned.”

Investigators also flagged long-standing issues with the kitchen at the hospital.

These were highlighted two years ago by civil society groups in Nelson Mandela Bay.

“The equipment in the kitchen is dilapidated and very old, has surpassed its life expectancy; [it] constantly breaks down and should be replaced. The breakdown of pots is also caused by the lack of trained staff to operate the pots and over utilisation of the pots which have reached their life span.”

The pots, which cost R500,000 each, should have been replaced but Gcaleka said the budget was not used. She added that new pots “could have been procured to replace the old pots that have reached their life span”.

“The Government Immovable Assets Management Act (GIAMA) provides for the management of an immovable asset that is held or used by a national or provincial department and to ensure the coordination of the use of an immovable asset with the service delivery objectives of a national or provincial department.

“The progressive realisation contemplated by the constitution can only be understood to mean that, no matter what level of resources the department might have at its disposal, it must take immediate steps within its means towards the fulfilment of the right of access to health services, by availing resources to address the challenges relating to the shortages of medical equipment, clinical and non-clinical staff which impacts negatively on the delivery of health care services in a progressive and effective manner. The conduct of the department in not addressing these challenges is inconsistent with the Constitution,” the report added.

While the Eastern Cape Department of Health has not yet commented on the Public Protector’s report, provincial health minister Ntandokazi Capa’s spokesperson, Sizwe Kupelo, said earlier in May that R143-million had been earmarked to improve services at Nelson Mandela Bay’s two largest hospitals, Livingstone and Dora Nginza. He confirmed last week that 10 new doctors and a number of nurses had been appointed at Dora Nginza Hospital. DM

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Damning report