Athol Williams’ Deep Collusion1 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 corruption there is influence but not control while in state capture there is control over selected functions where political power and economic decision making are concentrated.
While I am unaware of evidence of state capture directly affecting the health services possibly with one exception, I have during my career experienced the consequences of corruption some of which is detailed in my book2. Early in my managerial career in the Free State I received a dossier anonymously outlining alleged housing fraud involving several highly-placed individuals which I naively handed to the Office of the Premier and which was buried. Later I uncovered a fraud syndicate operating at the Manapo Hospital in Qwaqwa resulting in significant losses through the purchasing of goods by the hospital for restaurants, hair salons and other private use. While successful in uncovering the fraud and stemming the losses no-one was ultimately prosecuted as key documents mysteriously disappeared from the so-called safe place where they were being stored.
While heading the Western Cape Department of Cape I became aware of a Uruguayan businessman touting so-called oxygen generators and water purifiers. He came with a recommendation from the then National Health Minister expecting the department on the her instruction to purchase the oxygen generators to replace the existing suppliers. The oxygen generators were unable to provide oxygen of sufficient concentration or reliability and the issue fortunately died a natural death in the Western Cape. In other provinces however both water purifiers and oxygen generators unsuited for health facilities were procured with irregularities such as bribery and fraud and stood unused on hospital premises in various provinces. Years later on a visit to the Northern Cape as a member of a ministerial task team I came across one such water purifier standing unused in a rusting container on the grounds of a small rural hospital.
In the Gauteng Department of Health a previous MEC for Health faced charges of corruption and money laundering relating to two tenders worth R1,4 billion. In the North-West the Department of Health in February 2018 details were revealed of a R30 million pre-payment to a Gupta-linked healthcare company, Mediosa, with another R150 million to follow. The Guptas were, as is now an established fact from the findings of the Zondo Commission, the arch perpetrators of state capture in South Africa. The then health minister Dr. Aaron Motsoaledi on visiting the province in early March 2018 described the contract between the North-West Department of Health and Mediosa as, “an ATM card for the Guptas to withdraw money from the department!”
Most recently during the early phases of the COVID-19 pandemic fraud and corruption on a massive scale occurred related to the procurement of Personal Protective Equipment as well as the finding by the Special Investigating Unit that a R150 million communication contract was unlawfully awarded by the National Department of Health to Digital Vibes implicating the then Minister of Health and leading to his resignation.
There are other examples of which I am aware in which fraud and corruption have impacted on the ability of the public health sector to deliver quality health services but those I have listed indicate that while this is not a new phenomenon it is widespread. While I am certain that prior to 1994 the public health sector was not immune to fraud and corruption I would argue that the environment in which state capture has occurred was also the environment in which fraud and corruption flourished. As Williams outlines in his book, corruption occurs when illegitimate influence is exercised over state resources and that requires an environment in which that is possible.
The question is how and why does this environment arise? South Africa has a wide ranging legislative framework that is intended to ensure that procurement occurs according to strict requirements and to counter possible fraud and corruption. In fact, many consider the procurement framework to be overly restrictive. Nevertheless, as is outlined by Williams, if the systems of government are disrupted and key gatekeepers are removed and replaced, it becomes possible to circumvent the checks and balances that should operate to prevent fraud and corruption. An enabling factor is often the inappropriate influence exercised by those in positions of power. Politicians and others should not alone have primacy over aspects of the operation of government including decisions that impact on the regularity of financial management. When present, this results in a vulnerability that those in power can exploit for their own benefit and that of others.
This scenario is not unique to South Africa but the fragility of South African State institutions and public entities has resulted in an environment that has proved too easy to exploit. The situation was worsened by the fact that from the highest office in the country, under President Zuma, for almost a decade there was a concerted effort to subvert the systems and processes of government often couched as necessary steps to promote transformation. Resisting those intent on subverting systems and processes was often labeled as reactionary. Those who raised a red flag or refused to bow to the pressure exerted by people in powerful positions were categorised as opposing transformation and suffered serious consequences in both their professional and personal lives. However, the ultimate victims were the citizens of this country, often the poorest of the poor.
There is, in addition, a wider issue and that is the moral decay in the corridors of power that appears prevalent in South Africa. Surely the line between what is right and what is wrong should be clear to everyone and not require the presence of a legislative framework and watchdogs to monitor every action. The moral compass however has to be set by those in leadership positions and when they themselves are unable to do so, the consequences are that law and order are challenged. I recall being taken to task by a politician for imposing disciplinary sanctions on an official for what he termed the trivial offence of the theft of six tins of canned peaches and a dozen toilet rolls from a mental hospital. My response was that while what had been stolen could be regarded a trivial, the act of theft was not.
It is despicable that what I have termed moral decay has resulted in much needed resources destined for the healthcare of the poor being diverted for the benefit of a greedy and immoral minority. What is desperately needed are moral and ethical leaders who without coercion are willing in all of their actions, personal and professional, to set an example. While there will always be the small minority of miscreants in society who require law enforcement to control their actions, the majority should be able follow self imposed ethical and moral codes of behaviour, set by leaders with similar codes, that strenuously resist dishonesty, fraud and corruption. It is high time that these South Africans to step forward and take the lead.
