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…
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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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National Health Insurance in South Africa … will logic prevail?
Following my last post describing an analogy between the space shuttle disasters and the possibility of a system failure following the envisaged implementation of National Health Insurance (NHI) in South Africa my thoughts have returned to what I wrote in March 2022. This post reflected on the alternatives to what is proposed in the South African model of NHI. As I wrote then since 1994 the divide between those who have the ability to afford what in South Africa is termed private healthcare and those dependent on the State operated Public Health Service for the provision of healthcare has regrettably grown. The widening gap cannot be laid at the door…
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National Health Insurance … potential for system failure?
I recently read about the two disasters affecting the American Space Shuttles. The Challenger exploded shortly after launch in 1985 while the Columbia was destroyed 20 years ago over Texas on its 2003 return to earth after a 16-day mission. In both cases an accident investigation board (AIB) was established to investigate the causes of the disasters and make recommendations to address what had occurred. In the case of Challenger, a faulty o-ring on one of the solid rocket booster rockets, due to the abnormally cold weather during the launch, lead to flames leaking from the rocket igniting a catastrophic explosion in the shuttle’s external fuel tank destroying of the space…
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Politics, policy and implementation … there is a vast difference!
President Ramaphosa speaking at the 5th South African Investment Conference on 13th April 2023 made the following statements; “We are now confronted with the consequences of years of under-investment, mismanagement and corruption in our electricity, rail and logistics sector.” and that, “We are on a long journey to rebuild our country and recover ground we have lost. Our recovery is a mission and will take time to accomplish”. He continued that, “The lack of reliability in electricity supply weakens business and consumer confidence, taints international perceptions about our country and affects investment sentiment and decisions” concluding that, “If the focus of our struggle for liberation to end apartheid and achieve political freedom, the focus of our efforts must be to address inequality…