Following my last post, I have been reflecting further on the failures in public health care in South Africa since 1994. In doing so I reread a book, “Yenza – a blueprint for transformation”, published in 1998 that has been on my bookshelf since then. I worked with the author, Dr. Piet Human, on several occasions during the early days of my time as Head of the Free State Department of Health. Read some twenty years later, the optimism, idealism and hope of the years immediately after 1994, reflected in the book, are poignant given what has transpired since. The opening sentences of his book read as follows: “The present…
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Learning Lessons From The Past 25 years
Why are the public health services in a perilous state in many areas of South Africa? These shortcomings have been brought into sharp focus by the impact of the COVID-19 pandemic. It is true that in 1994 at the time of the democratic transition in this country, that the health services bore the scars of decades of racial segregation. Hospitals and clinics were divided along racial lines with facilities for patients of colour inferior to those available to white patients. When I moved into health management in 1995 as Head of the Free State Department of Health, this difference was a stark reality. It was mirrored by the realities experienced…
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COVID … is there another way to navigate through difficult times?
I have been reflecting on the latest response by Government to the COVID-19 pandemic. The “second wave”, it has been announced, is upon us in South Africa with even the addition a new COVID strain. Daily there are reports of an increasing count of positive COVID tests, intensive care admissions and sadly COVID-related deaths. So what has been the response to the increase in COVID cases? In a previous article I reflected on the need to develop a community-based response rather than a heavy-handed law and order response. As a seasoned health professional, I fully understand the need to carefully husband the health care resources at the country’s disposal to…
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Command or Persuade … How people are influenced
In my previous post I argued against the imposition of further “lockdown” measures to address the rising number of COVID-19 cases in areas of South Africa. This has seemed to be a dissenting view when compared to what is the reported policy direction of government to address the resurgence of COVID-19 in areas of South Africa. I was, however, encouraged to read an article “Call to Action: A people-centred approach to disease prevention in the era of COVID-19” published in the Daily Maverick of 30th November 2020 penned by Yogan Pillay and Tracey Naledi. The article echoes many of the sentiments that I have expressed in articles over the preceding…
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The Difficult Dilemma of COVID-19 in our 2020 World!
I write this article as a 72-year old man with hypertension well-controlled on antihypertensive medication and as such an individual who falls into the group of individuals at higher risk for a more complicated course of COVID-19 should I acquire that infection. I am also a doctor and spent my professional life as both a practicing specialist clinician and a manager of health services. The reason for my stating this at the outset will become apparent to the reader. In South Africa the surge of COVID-19 cases and COVID-19 associated deaths overall first peaked around July of this year, 2020, and subsequently declined. Prior to the surge the country went…
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Decision Making in Government … the good and the bad!
I have just finished reading the book written by John Bolton, “The Room Where It Happened”. Bolton was the National Security Advisor of the United States and worked closely in this position with President Trump. It is a startling analysis of how decisions were made or not made at the highest level of the United States Government during his relatively short term of just over a year as the National Security Advisor. While a number of books have been written reflecting the experience of working with President Trump, this book is unique in that it reflects the experience of a political insider, a person who previously had held senior positions…
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“Accountability” essential for a successful nation!
“Accountability” as defined in the Merriam-Webster dictionary is “the quality or state of being accountable i.e. an obligation or willingness to accept responsibility or to account for one’s actions”. My professional training as a doctor made me aware of my accountability for my actions as a health professional. Accountability directly to my patient, a child in my case as a paediatrician, their parents and extended family. Accountability to the professional body with which I was registered to practice as well as to my employer, a public sector health department and university. Later when I moved into health management in 1995, I became legally accountable in terms of the Public Finance Management Act…
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COVID-19 … social distancing is now the last line of defence.
In the term “social distancing” I include the full spectrum of measures introduced to counter the spread of the coronavirus. With the lifting of almost all the restrictions on the movement of individuals in South Africa “social distancing” to prevent the spread of the coronavirus becomes the last line of defence. Recently pictures on social media have shown groups of apparently well educated and informed people in South Africa happily congregating in groups without masks completely ignoring the need to remain at a safe distance from one another. Counter intuitively some are those who continue to work from home due to their age or because they have co-morbidities. For riders…
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Leadership or management … the challenge of making decisions
I have been reflecting on the challenges President Ramaphosa faces in dealing with the COVID-19 pandemic and his struggle to match the need to consult widely and the need to take decisive decisions that have and will affect the lives of so many. Leadership, irrespective of position, requires the ability to motivate people and take an organisation in a given direction possibly different from that which it had previously taken. Management on the other hand involves systems and processes that allows an organisation to function efficiently and achieve its goals and objectives. Both expect those involved to act in an ethical and honest manner. This lead me to think about…
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The Cancer of Corruption in Health
Corruption is a word that has become all too familiar in the lexicon of the ordinary South African. Billions rands of government funds have ended up in the hands of corrupt individuals many of whom by virtue of their positions should have been people with integrity and above reproach. Transparency International reports that the Corruption Perceptions Index places the country at 71 out of the 180 countries. The 2017 Corruption Watch annual report quotes the then Economic Development Minister as estimating that corruption costs the public sector at least R27 billion annually. During my initial experience heading the Free State health Department in the late 1990’s I uncovered corruption at…