Currently there are according to reports several hundred unemployed young doctors in South Africa, a country that according to recommended doctor to population ratios requires more and not less doctors. It has been previously reported that some amongst other categories of health professionals are similarly finding it difficult to find employment in the South African public service leading to some even emigrating from this country to find work elsewhere. This situation has been attributed to the shortfall in funding for public health services. The current financial crisis in government departments largely results from a wage agreement with organised labour that increased the salaries of all public servants by 7%. These…
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Facing budget shortfalls in the South African public health sector
In 2023 in my health blog I described the budget shortfalls facing most South African government departments. From my perspective the most pressing consequences of these shortfalls are those affecting provincial health departments. Recent developments including an open letter addressed to the Minister of Finance from health professionals in the Western Cape have again highlighted this issue. Many provincial health departments in South Africa have a history of what are euphemistically termed “accruals”, which stated otherwise is an inability to settle outstanding accounts within either the required 30 days or even a financial year. These departments have in the past been unable to remain within their approved budgets. An implication of “accruals” is…
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2023 … some reflections on the year that was!
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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Cystic fibrosis … the conundrum of scientific progress
I recently read a review article on cystic fibrosis which highlighted for me the tremendous advances in the field of medicine since I left active clinical practice as a paediatrician in 1995. During my training as a paediatrician and subsequently as a senior research fellow I worked for various periods in a clinic at the Red Cross Children’s Hospital that managed children with cystic fibrosis. As a result of this experience when in 1983 I moved to Bloemfontein, I started a similar clinic to manage children with the condition in the Free State province. Over the 12 years that I spent in the Department of Paediatrics and Child Health at…
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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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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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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…