A recent read of Francis Fukayama’s Liberalism and its Discontents set me thinking. For someone who is not a social scientist despite being a short book of 174 pages, it is a tightly written, challenging but stimulating read, which I can recommend. I have in fact read the book twice and continue to delve into various chapters in the book. Having in the past been taken to task for my application of the so-called neoliberal policies of budgetary austerity faced with a limited health budget, the book made me think whether I am indeed a liberal with socialist leanings, which I had always considered myself to be, or whether over…
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Winter of discontent … again!
My first post on my health blog on 13th July 2020 had the title. “Winter of discontent”. I am again posting a piece with the same title as on that date. The country has since emerged from the COVID-19 pandemic, which in July 2020 was still new to our experiences but dragged on with questionable measures taken by government over the subsequent almost two years with disastrous consequences for the lives of so many South Africans. At that time the country had experienced euphemistically termed “load shedding” but more aptly the failure of a vital state entity ESCOM to provide enough electricity to keep the wheels of industry turning and…
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Reflections on life in my seventies …
With the onset of winter in South Africa, the time of the “sere and yellow leaf”, I am in a reflective mood as my 74th birthday looms later in the year. I retired from a full-time career as a specialist paediatrician and then a senior government bureaucrat in 2015 having headed a university department of paediatrics and managed two provincial departments of heath in South Africa. Subsequently I have remained busy as a consultant and on the boards of various entities. 2023 marks 50 years since I qualified as a doctor in 1973 and the world around me has changed dramatically since that milestone and as befits that anniversary a…
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COVID-19 Lockdowns … can we learn the lessons?
A recent study published in the South African Journal of Science by Bradshaw et al provides interesting reflections on the number of reported COVID-19 deaths in the four waves of coronavirus infections compared against the total number of excess “natural” deaths during the same periods. While in one province, Western Cape, the ratio between reported COVID-19 deaths and the excess natural deaths was 69% in some other provinces, Mpumalanga and Limpopo respectively, the ratios were as low as 10 and 13%. From this it appears that quality of the provincial data systems varies markedly. The data also indicates that the quality of official COVID-19 reporting may be worsening over time. The…
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Echoes of State Capture and moral decay … a health perspective
Athol Williams’ Deep Collusion was a recent read. The book outlines the role of the international consultancy Bain & Company in the “capture” of state entities such as Telkom and the South African Revenue Services (SARS) during the Zuma presidency years. Of particular interest to me was the author’s conceptualisation of the process of state capture. He compares the differences between corruption and state capture. The different degrees and influence and control (decision making) that “illegitimate and unelected parties” have over the functions of the state determines the differences. In what he categorises as a “just democratic state” there is no influence or control by illegitimate parties over state resources. With…
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National Health Insurance … what is government saying?
I have written on several occasions about the proposed National Health Insurance Bill (NHI) that is currently before the South African parliament. I have proposed a rational debate and have raised my concerns about what is proposed in the draft legislation. I was thus interested in an interview with Dr Nicholas Crisp, the deputy director-general tasked with National Health Insurance in the National Department of Health published in the Sunday Times on 3rd April 2023. Dr Crisp, who is one of the most senior officials in the National Department of Health, was posed a series of questions by Chris Barron and his responses, if he was correctly quoted, I found…
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Walking the Road of Healthcare in South Africa now available on Amazon
I am glad to inform readers and subscribers to this page that my book published last year by Quickfox Publishers is now available on Amazon Books in either Kindle ebook or hard copy versions. In recent posts on this site I have referred to the book and I feel that what I have chronicled in the book remains relevant to the discourse on the future of healthcare in South Africa and elsewhere. I can also recommend the book to those who are either embarking on a career in health management or already in the thick of the challenges that such positions bring. I am glad that the book now has…
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National Health Insurance … what are alternatives?
I have in recent posts referred to my concerns related to the National Health Insurance (NHI) draft bill and it is only reasonable to ask, “So if you are concerned what alternatives would you recommend or consider? It is easy to criticise but if it is accepted that the current status quo for the majority of South Africans is unacceptable, rather than carping on the sidelines offer alternatives!” So much has been written in the last few years on this topic that I am hesitant that I can add anything of value to the debate but for what is worth here are my views! Since 1994 the divide between those…
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The more things change the more they stay the same …
The more things change the more they stay the same Ah, is it just me or does anybody see The new improved tomorrow isn’t what it used to be Yesterday keeps comin’ ’round, it’s just reality … The words of a song by Bon Jovi echo in my mind as I reflect on the state of South African healthcare. The song itself echoes the words of the French writer Jean-Baptiste Alphonse Karr from the 1800’s who wrote that “plus ça change, plus c’est la même chose” – the more things change, the more they stay the same – indicating that turbulent changes do not affect reality on a deeper level…
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From policy pronouncements to implementation … a seemingly difficult path!
I was struck that many of the pronouncements by President Ramaphosa in the 2022 State of the Nation Address (SoNA 2022) are noble in intent but fail to address the mechanism by which policy pronouncements become a reality. While it is correct, as the President did, to allude to the consequences of State Capture and the COVID-19 pandemic that have set the country back, these alone cannot be the reasons why South Africa finds itself in the perilous position that it does today. In fact, from the Constitution down this country has some of the most progressive policies and legislation in the world but has failed in many areas to…