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…
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Nutrition … a marker of poverty or privilege
A recent headline in the Daily Maverick read as follows, “Child malnutrition in the Eastern Cape qualifies as a disaster” quoting from a South African Human Rights Commission report on child malnutrition in the Eastern Cape province. The article cited the fact that 25% of the provinces’s children have stunted growth and over the period of one year over 1000 children were diagnosed with severe malnutrition of whom 120 died. Juxtapose this with a more recent media headline in a Afrikaans National Sunday Newspaper which reads translated from the Afrikaans, “You cough up R24 000 per head so that Cyril’s (the State President) guests can feast while they fly”. The…
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Accountability … is it a reality or a myth?
Reading various media reports about the actions of individuals, politicians, state entity and government representatives, I am struck by how often the word “accountability” is so easily and even glibly used. How often do we hear that a particular person must be held accountable for their actions and how often in the end does it appear that they were not? Accountability is simply defined as an “obligation or willingness to accept responsibility or to account for one’s actions”. It is the state of being accountable, that is being subject to giving account which implies being able to “explain or to be answerable for one’s actions”. In a political sense government…
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Thoughts after recent travel outside of South Africa …
I recently had the privilege to travel to Scotland, Austria and Germany and while this post is not directly health related the connection to good governance and government on which effective healthcare delivery depends is clear. In Scotland my wife and I visited my daughter, son-in-law and two grandsons on the croft in the Scottish Highlands that they purchased shortly after their arrival in Scotland over three years ago. In the last 18 months the family have constructed a barn on the property without outside assistance, something that they would have been unlikely to undertake in South Africa. Crofts which are a feature of the Scottish Highlands established in the…
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Healthcare … a victim of a self-inflicted government funding malady?
Various questions trouble me when I hear that a public sector health department has a major shortfall in the budget allocation that will result in people being unable to receive the healthcare that they need. Who is accountable? Who is responsible for the consequences? Is it immoral that the cost of healthcare should limit access? Who should decide which treatment should not be provided? What is an acceptable package of healthcare? What can be done to alleviate the problem? I could go on … I have great empathy with a doctor who although the treatment plan is clear must inform the patient that due to affordability constraints that either a particular…
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Oversight and governance versus Management
Recently pronouncements by both the Minister responsible for electricity within the national cabinet and the chairperson on the Eskom Board drew to my attention the differences between oversight, governance and management. In both cases they appeared to make statements that in my initial thoughts belonged with management rather than a politician and a board chairperson. It is often a sensitive issue when management is faced with a managerial politician or a board that seeks to take management decisions. Eskom, in South Africa, is a State owned entity (SOE) (also defined in the the Public Finance Management Act as a Major Public entity) that provides almost exclusively the electricity that powers the national…