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…
-
-
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…
-
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…
-
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…
-
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…
-
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…
-
Age and Ageism … some further thoughts
The recent withdrawal of President Joe Biden as a candidate for the upcoming American presidential election and the various responses to that event set me thinking once again about the manner in which ageing is addressed in the world today. In a world that has become progressively more politically correct we are made aware of the need to be sensitive to discrimination in all its various manifestations. Ageism simply stated is the prejudice or discrimination against people on the grounds of their age. President Biden a man of 81 had been the presumptive Democratic Party candidate elected through the process of primaries across the various American states but in recent…
-
Government of National Unity (GNU) … illusion or reality?
The May 29th 2024 election delivered a parliament for the first time in the 30 years since 1994 in which no single party had a majority. During the past 30 years the African National Congress (ANC) had a significant majority at both national and provincial level with the exception of the Western Cape province where since 2009 the opposition Democratic Alliance had a majority which was maintained in the 2024 election. Clearly after the 2024 election the ANC which was the largest party with just over 40% of the votes had to seek coalition partners. After tough negotiations a coalition was formed with the Democratic Alliance as the second largest…
-
South African Public and Private Healthcare … there is good and bad in both
The recent high profile signing of the National Health Insurance Act set me thinking about the public perceptions of healthcare in South Africa. In a South African context one hears much about problems experienced in the public health sector but less about those in the private health sector. In the public health sector issues relate to the poor quality of healthcare while in the private sector the issue most frequently is the high cost of services. I have had the advantage of having worked for forty years in the South African public health sector and subsequent to my retirement being part of, or having undertaken, various investigations into public health…
-
National Health Insurance NHI … the “final countdown” … or not!
In May 2023 I wrote a post titled “National Health Insurance … will logic prevail?” Now a year later, in May 2024, it appears to me that emotion and political necessity rather than logic has prevailed certainly amongst the ruling party. I do not intend to repeat an analysis of what is contained in the now NHI Act signed by President Ramaphosa but rather to consider the consequences of his doing so 15 days prior to a general election in which the political party which he heads faces for the first time possible, but probably unlikely, election defeat. The President has defended his actions with the argument that the delay…
