Recently a politician commented that despite a local municipality receiving a “clean audit” it bore no relation to the effective delivery of municipal services. The implication was that the positive audit result was of little benefit to those living in that town. This set me thinking about the value of annual “routine” regularity audits which are different from “forensic audits”. The latter are important when financial irregularity and fraud are suspected. In South Africa all government departments and entities, which includes municipalities, are audited annually by the Auditor-General of South Africa (AGSA). The AGSA is a Chapter 9 institution established in terms of the South African Constitution accountable to the…
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Public health services … its a question of staffing
It is a matter of public record that public health services in South Africa are facing challenges. Frequently one will hear of shortages of doctors, nurses and other health professionals. The shortage of clinical staff is advanced most often as an important cause of these challenges. In addition, the reason advanced for the predicament is that public health services are underfunded reflecting the constrained financial environment in which this country finds itself. While all of this is indeed correct, a factor that is largely ignored is that as a consequence clinical posts are prioritised over what are regarded as less essential non-clinical posts. Again while this appears to be a…
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Elon Musk and management lessons
I have recently finished reading the 2023 biography of one of the most controversial people of our time, Elon Musk. Hated by many and loved by others but a person about whom very few have neutral feelings. His support for President Trump, notwithstanding their recent fallout, and his outspoken dislike of what he perceives as “woke” has heightened the dislike of many for Musk. To an extent, this has overshadowed his significant and wide ranging achievements from Tesla which has pioneered electric vehicles to SpaceX and Starlink which have eclipsed in many respects the National American Space Agency (NASA) and other communication networks. The biography highlights the complex nature of…
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The challenge of tolerance
In my last post I discussed accountability or what I perceived to be as the lack thereof. In response a colleague, whose opinions I value, took issue with a statement that I made related to the event that precipitated the current ongoing and violent incursion by Israel into Gaza. Whilst I would not entirely agree with her interpretation of what I wrote, I have empathy for and understanding of her opinion. Indeed I agree with her that the history of the Middle East is such that the current events must be placed in the context of what has gone before. Nevertheless what struck me in our brief interaction was the…
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Where is accountability?
Accountability can be reflected by an action as simple as stooping to pick up a sweet wrapping that one has inadvertently dropped rather than walking on and leaving it for another to clean up. Accountability is reflected by the driver of a motor vehicle who slows and brings his vehicle to a stop as the traffic light turns from orange to red rather than hastening through when it has already turned red risking an accident. Simple acts, but both have consequences for which there is individual accountability. In September 2020, almost at the inception of this health blog, I wrote for the first time on more serious aspects of accountability…
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Echoes of McCarthyism in America
I am a health professional and healthcare is an issue very dear to my heart. But healthcare can so easily become the victim of issues beyond its control. The recent events surrounding the withdrawal of the funding of key health initiatives around the world by the United States is an example of this. I have recently written about the danger of dependency by a country on foreign aid, but the danger of what has transpired goes much further than that. America is a democracy and its president was elected by more than 50% of those who went to the polls in what most would accept was a fair democratic process…
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Donor funding … a double edged sword
An Executive Order from the United States President halting foreign aid for an initial 90-day review period, amongst others to South Africa, has had far reaching implications around the world. South Africa has in addition been more specifically targeted with a further Executive Order indicating that all financial transfers to South Africa are halted. The major health implication for this country was funding allocated via PEPFAR and USAID for a wide spectrum of health related initiatives many of which are focused on programs supporting people living with HIV and AIDS. The sudden and largely unexpected actions of the US President have caused chaos and uncertainty. While it will be argued…
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Inspired by Youth … anything is possible!
I was privileged recently to attend a performance of the Ndlovu Youth Choir. What a stunning show it was which entranced a full-house at the Artscape Theatre in Cape Town. All the the members of the choir, which was formed in 2009, come from a small village, Elandsdoorn, in the Moutse district of Limpopo South Africa. Achieving prominence after their participation in the America’s Got Talent (AGT) television show, they have performed across South Africa and in many countries around the world, most recently at New York’s famed, Carnegie Hall. The story of the choir is an inspirational and well documented one which I will not repeat, but their performance…
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The Consequences of Power and Privilege
I have not written anything on my website since September 2024. Call it writer’s block or a sense of disillusionment with the world that I see around me but I have lacked inspiration despite the many issues that have crossed my path. Conflicts abound across the globe some becoming newsworthy for a while only to be superseded by others in the relentless news cycles that occupy the news channels of the world media. Images of displaced people as a result of various conflicts or natural disasters fill our television screens. The poor remain poor across the world with even basic services to communities crumbling in many places. But amongst all…
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The Life Esidimeni tragedy … a lesson that must be learned
The Life Esidimeni tragedy happened in the early months of 2016 when a long-standing contract with the Life Healthcare Group was terminated by the Gauteng Department of Health. Thereafter despite warnings that this was unwise around 1500 vulnerable mentally retarded patients were transferred from Life Esidimeni facilities in Gauteng to Non Governmental Organisations (NGO’s) in what was known as the Marathon Project. Many of the NGO’s did not have the capacity or resources to manage patients of this nature and as a result at least 144 patients died of neglect and many more suffered inhuman and degrading conditions. This occurred less than a year after I had retired as Head…
