At this time last year I published a similar post reflecting on the happenings of 2022. It is interesting to reflect on what I said then in the light of what has transpired in 2023. In December of 2022, the echoes of COVID-19 still remained, something that has now almost vanished from the public consciousness despite reports of new variants, similar to the amnesia that may follow a very traumatic event. In Britain, however, the country continues to anguish over the consequences of what was and what was not done during the pandemic in the public hearings of a commission of inquiry into the actions of those in positions of…
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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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South Africa … how long are the shadows of apartheid?
In recent days both President Ramaphosa and a cabinet minister have attributed current issues in South Africa to the legacy of apartheid. Without doubt legacies of apartheid remain in this country almost thirty years after the birth of a democratic and non-racial South Africa. Glaring examples of this are the spatial distribution of South Africans and the significant differential of income and employment amongst South Africans which in large measure remains defined by race. However, can the tragic events of a fire in a “hijacked” Johannesburg building be attributed to apartheid as was done by a cabinet minister? Is the poor state of many municipalities across the country due to 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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J Robert Oppenheimer, decisions and consequences with which we live!
I was reminded recently of my connections with Princeton and indirectly The Institute for Advanced Study when watching the 2023 film Oppenheimer, a cinematographic biography of J Robert Oppenheimer. I was born in October 1948, by chance in the United States when my parents were living in Princeton New Jersey and where my father, a mathematician, was a fellow for two years at The Institute for Advanced Study. J Robert Oppenheimer was the theoretical physicist who headed the Los Alamos Laboratory of the Manhattan Project that culminated in the detonation of the first atom bomb in 1945 in New Mexico and subsequently the atomic bombs dropped on the cities of Hiroshima…
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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…
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Politicians, policies, plans and their promises
Recently the South African President has extolled the virtues and achievements of the political party that he leads. This is totally understandable since as the leader he faces an election in 2024 which according to analysts could be the closest since the first democratic election in 1994 when the ANC assumed power. There have undoubtedly been achievements and the President focused on these including the fact that many indigent South Africans now receive a social grant that eases the poverty with which they grapple daily. In the public health sector, of which I have first-hand experience, there have been significant achievements for example the introduction of a comprehensive national immunisation…
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Cholera in South Africa … is it a marker of government failure?
As a paediatrician I specialised in childhood diseases of the gastrointestinal tract. I obtained a doctorate for a study of infants presenting to the Red Cross Children’s Hospital in Cape Town with acute diarrhoea. In the introductory chapter of my thesis, I quoted the researchers Rohde and Northrup (1975) who stated that, “the incidence of diarrhoea is more closely related to socioeconomic conditions than to climate, to poverty rather than place.” At that time (1981-1982) diarrhoea in infants was an annual summer epidemic in Cape Town located largely amongst the black and coloured communities of the Cape Flats. In recent times the frequency of the disease amongst children from these…
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André de Ruyter … Truth to Power … a must read!
I have just finished reading André de Ruyter’s book Truth to Power My Three Years Inside Eskom, which I believe should be read by South Africans interested in why the country is the way it is today. Unlike de Ruyter, I spent my whole professional life in the public sector, while he entered Eskom as the CEO having only worked in the private sector. He acknowledges that he completely underestimated the constraints imposed on him as the Eskom CEO by the public service regulations and processes as well as political oversight. As with de Ruyter when I moved from a clinical role in health services into management in 1994, I experienced…
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Leadership … it’s what South Africa urgently needs!
Leading a country, a business and even a sports team is not an easy task. In the “olden days”, the king or emperor would lead his soldiers into battle risking his life at the forefront of the fighting. Those who would be king could not be weak or indecisive as the consequences were dire. Similarly, the CEO of a successful company or the captain of a winning sports team must lead from the front and be able to decide to change strategy when an initial strategy is failing. Decisive leadership not necessarily group consensus is a mark of success. Recent reports reflect the frustration of business leaders with the indecisiveness…