This week I accompanied my wife to apply for a new South African passport at a Home Affairs Office that I will not name but located within the Greater Cape Town area. The office opens its doors at 8am but when we arrived just after 6:30am on a midweek morning the queue stretched along the front of building and around a corner. This was where we joined the queue of South Africans patiently waiting in an orderly fashion in the dark for the doors to open. While most people were wearing masks there was no social distancing. Only as it became light did I notice the red lines painted on the tarmac which is seems had been painted to indicate the distance people should stand apart from one another. Also as the darkness lifted I became aware of the abundant litter strewn where the queue had formed, most of it not recent.
Standing in the cold morning air we watched as the sky lightened and the staff trickled in as the opening time neared. No sign of chairs obliged the elderly woman in front of us using a single crutch to walk to sit on a crate brought by a young man possibly her grandson. After the doors finally opened at 8am progress was painfully slow with both those making applications for passports and identity documents (ID) on our side of the doors and another queue on the other side for those waiting to collect said documents being admitted to the building alternatively. There was also a third a much shorter queue in the middle apparently for those registering births and deaths. It appeared that parents with schoolchildren were preferentially admitted although no accommodation appeared to be made for the elderly. A grey-haired elderly woman was peremptorily told to join the back of the queue, which at that stage disappeared around the corner and down the street.
A notable arrival was what appeared to be the manager of the Home Affairs offices well after opening time at around 8:30am. He parked his car under the only covered parking spot where we had joined the queue almost 2 hours earlier. The portly gentleman removed his briefcase from the car’s boot and pointedly ignoring the queueing clients and litter alongside his vehicle hurriedly entered the building.
My wife finally entered the building after a wait of almost three hours to be confronted by equally slow progress inside since according to an official the staff complement had been reduced to 75% due to “COVID-19 restrictions”. This in a building crowded with people who had spent several hours in close proximity of each other outside the building. My wife completed the application process to renew her passport five hours after our arrival at the Home Affairs building. Sadly she will have to repeat the process to collect the document hopefully in a few weeks time, although thankfully the collection queue seemed to move a tad faster than that for applications.
Why am I recounting this experience on a health blog? Well the government seems resolute to maintain central control of the COVID-19 vaccination campaign and the track record of the ability of government to effectively and efficiently manage existing large scale programs such as that required from Home Affairs or the provision of social grants by Social Development does not inspire confidence. An ID is a necessity for every citizen as is a passport although for a smaller proportion of the population and the sole source of these documents is an in-person visit to a Home Affairs office such as that which I have described.
The office that we attended has a reputation for better service than many others and I shudder to think of the experience of others at these offices. I am certain that the process to obtain an ID or passport could be streamlined and made more efficient. If the manager of the Home Affairs Office that we visited had simply walked the queues, he would have become aware of the bottlenecks and at the very least the litter strewn outside the building. Toyota pioneered the so-called “Lean management system” which encourages managers to spend time on the production line. To summarise very briefly, this system creates a continuous process to identify problems, standardises tasks, levels out the workload and uses visual controls so that no problems are hidden. How much better could the service at the Home Affairs Office have been if the manager, who arrived late for work, had walked the “production line”, identified bottlenecks and exercised visual control of the process for which he was responsible?
To date the response of the South African government could be described as one of “democratic centralism” that dominates the approach of political movements arising from a communist doctrine. (https://www.merriam-webster.com/dictionary/democratic%20centralism) Hence the structure of the Coronavirus Command Council and the view that once a decision has been made all must tow the party line. Dissent is not tolerated and as we have seen the consequence is removal from ministerial coronavirus advisory committees. Given this reality it is necessary to question the viability of the government plans to vaccinate the South African population. Why is it that South Africans, able to do so, are traveling to neighbouring countries with far less robust health systems to receive COVID-19 vaccines? Resisting the consequences of democratic centralism and empowering civil society to raise alternatives now becomes imperative.
In this spirit Mark Heywood and Marcus Low writing recently in the Daily Maverick (https://www.dailymaverick.co.za/article/2021-05-14-how-to-vaccinate-millions-as-quickly-as-possible/) propose reducing the controls and that government should stop attempting to micromanage the COVID-19 vaccination program. They make the argument that the alternative should be actions that allow the vaccination of as many “vaccination keen” people as quickly as possible. “Let public and private clinics run their vaccine programmes as they see fit – just make sure they get the vaccines” is their plea. The possibility of vaccination site queues at a limited number of sites becoming super spreader events certainly looms large after my Home Affairs queue experience. In addition, having been approached in the same week by an acquaintance seeking a way to bypass the queues at a State hospital, the views of Heywood and Low certainly resonate with me.
I have previously written about my concerns related to the lack of logistics expertise in government and the health department in particular. The vaccination program is even with the best logistics expertise in the world a formidable challenge and for government to seek to micromanage this program is a recipe for at best delays and frustration and at worst failure. With a “third wave” of COVID-19 infections beckoning and mutterings about restrictions being re-imposed that the country on its knees economically can ill afford, this is a time to take a different path. I would echo the views of Heywood and Low. Open up the process to a wider number of role-players while only putting in the necessary controls to ensure both effectiveness and safety but also measures to curb the penchant of certain segments of our society to unduly benefit from any activity in which government is involved.
South Africa has a population that is keen to be vaccinated (estimated at 71% in a recent survey) so let us as a country make every effort to get vaccine into as many arms as possible as quickly as possible! Of course the vaccination program will face challenges along the way but if all South Africans pull together these will be overcome and the country will be able to return to dealing with the many challenges that we face other than COVID-19.
