Health commentary,  Political commentary

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 program that has reduced the impact of childhood illnesses and the extension of primary healthcare across the country that has improved access to healthcare for the poor albeit of a questionable standard in many facilities. In addition many houses have been built again not enough to prevent sprawling informal settlements surrounding town and cities and may have benefited from electrification when the supply is not interrupted by load shedding. In his view this is proof of the realisation of promises made by his political party in terms of their election manifesto.

But the reality is that so much more could have been achieved in a country ruled by a political party striving for a better life for all South Africans. That reality is set out concisely in the Bill of Rights that serves as the introduction to the South African Constitution. In this document, to highlight only a few rights, citizens are entitled to freedom and security of person which includes freedom from all forms of violence from either public or private sources; to an environment that is not harmful to their health or well being and to have access to adequate housing, healthcare services, sufficient water and food and social security. Based against this template there are many promises included in the manifesto of the party that he leads that have not been kept, in particular to deliver a majority of the population from poverty.

The policies of the current government are ostensibly framed in terms of the  concept of a National Democratic Revolution (NDR) formulated many years before the democratic transition of 1994. The NDR calls for “national liberation” of African people, eliminating all forms of racially based discrimination or privilege and “restoring the land and wealth to the people of the country, guaranteeing equality and opportunity to all”. The NDR, is theoretically the binding ideology of the Tripartite Alliance that, again theoretically, still determines the policies of the current government. The NDR has become more relevant in recent years with the increasingly strident calls for what is termed Radical Economic Transformation (RET) by political factions both inside and outside of the ANC.

The Freedom Charter adopted by the Congress Alliance lead by the ANC in 1955 at the Kliptown Johannesburg Congress of the People set out then what would be required in a democratic South Africa envisaging “the nationalisation of mines, banks and monopoly industries and sharing the wealth among its people” stating that “the land shall be shared among those who work it”. This was seen as a first step towards a National Democratic Revolution.

There are many detailed analyses and critiques of the progression of the policies of the ANC in terms of both the NDR and the Freedom Charter by social scientists more erudite than me1and I do not intend to attempt to repeat these here. I have briefly sketched this background to provide context to the further progression of the various plans of government since 1994.

In the run up to the first democratic elections the promises that were made by the ANC in their manifesto were set out in the Reconstruction and Development Plan (RDP) drafted in terms of the Freedom Charter. To an extent the RDP deviated from the more socialist tenets of the Freedom Charter and reflected somewhat more Neo-liberal policies but was comprehensive and ambitious in its formulation. The RDP achieved some success in establishing an extensive welfare system, implementing free healthcare for women and children, building clinics and feeding children at schools. As a result of many factors, not the least of which was an inability to implement many of the ambitious goals of the RDP and a lack of resources to do so, the Growth, Employment and Redistribution (GEAR) strategy was then adopted  by government to replace the RDP in 1996. This was opposed by both COSATU and the SA Communist Party (SACP), the other members of the Tripartite Alliance. GEAR was based on free market principles and economic growth to address unemployment and poverty. Although resulting in some improvement in financial management and reduction of fiscal deficits and inflation, GEAR was criticised, as was the RDP, as a stricter Neo-liberal policy resulting in job losses and increased poverty.

This was followed in 2006 by the Accelerated and Shared Growth Initiative (AsgiSA) aimed at stimulating economic growth and halving unemployment by 2014. Quoting from the policy document the “objectives were to introduce policies, programmes and interventions that would allow the South African economy to grow enough to halve poverty and unemployment between 2004 and 2014”. The policy managed to increase the focus on infrastructure spending as a means to increase employment and economic growth as did the New Growth Path (NGP) which superseded it in 2010. Neither AsgisSA or the NGP could claim to have fully achieved their objectives partly due to their limited time span.

The NGP was followed after a very brief period in 2012 by the National Development Plan 2030 (NDP)2with a focus on economic growth as the path out of unemployment, poverty and inequality. The NDP, which is a 484 page comprehensive document dealing with all sectors of South African society, was developed by a 26 person National Planning Commission initially chaired by Trevor Manuel, a previous Minister of Finance, with the current President Cyril Ramaphosa as deputy chair. The NDP states that the plan aims to achieve a “decent standard of living” for all South Africans and sets out a vision filled with ideals and objectives that few would dispute. “Good practice” examples of national development planning quoted in the NDP are Uganda, Namibia, China, Malaysia, Ethiopia and Russia are possibly indicative of the thinking in the National Planning Commission, however, as with the RDP and GEAR the NDP is criticised by those further on the political left as anti-poor and seen to leave the existing patterns of ownership intact with a minimalist role by the state.

Since the NDP remains in 2023 the macroeconomic policy of the South African Government lead by President Ramaphosa it is worthy of more detailed consideration. The National Planning Commission identified in an initial 2011 report the challenges facing South Africa, not dissimilar from what most would identify as challenges facing South Africans in 2023. These challenges were:

  1. Too few people work
  2. The quality of school education for black people is poor
  3. Infrastructure is poorly located, inadequate and under-maintained
  4. Spatial divides hobble inclusive development
  5. The economy is unsustainably resource intensive
  6. The public health system cannot meet demand or sustain quality
  7. Public services are uneven and often of poor quality
  8. Corruption levels are high
  9. South Africa remains a divided society.

The NDP released the following year listed the following objectives to be achieved by 2030:

  • Uniting South Africans of all races and classes around a common programme to eliminate poverty and reduce inequality with the Gini coefficient reduced from 0.69 to below 0.6.
  • Encourage citizens to be active in their own development, in strengthening democracy and in holding their government accountable
  • Raising economic growth, promoting exports and making the economy more labour absorbing
  • Focusing on key capabilities of both people and the country
  • Capabilities include skills, infrastructure, social security, strong institutions and partnerships both within the country and with key international partners
  • Building a capable and developmental state
  • Strong leadership throughout society that work together to solve our problems

The implementation of the NDP was intended to be framed in the initial planning cycle of 2014-2019 captured in what is termed the Medium Term Strategic Framework (MTSF). The 2019-2029 planning cycles were intended to “initiate the remaining activities built on achievements of the previous cycles”. A complex matrix of role-players and activities was set out according to which what was envisioned in the NDP 2030 would be implemented.

The third National Planning Commission was appointed by President Ramaphosa in 2021. In a recent submission to the National Council of Provinces, Professor Tinyiko Maluleke, the current Deputy Chair of the Planning Commission stated what a majority of South Africans experience on a daily basis and that is that “the vision of the National Development Plan (NDP) for 2030 is not on course”. Maluleke noting that the country is now within seven years of 2030 elaborated further on the current status of the NDP outlining that many of the objectives had not been achieved.

The ANC’s attachment to the then Soviet Union and now Russian Federation is well-known and thus it is interesting to review the history, successes and failures of five-year plans in that country. There were 13 Soviet five-year plans from 1928 onwards until the fall of the Soviet Union in 1991. The USSR, a communist state, had a state planning commission (Gosplan), echoed to an extent by the South African Planning Commission, which determined targets centrally often ignoring the realities in various sectors of the Russian society and economy. While successful in transforming certain aspects of society and promoting massive industrialisation, a collapse of agriculture was attributed to the implementation of the early five-year plans. The fact that the USSR collapsed in 1991 and many its satellite states in Eastern Europe moved away from communism toward becoming Neo-liberal democracies resulting in what Francis Fukuyama, describing that move toward liberal democracies, termed the “end of history” in his book first published in 1992.3 By the “end of history” he postulated that in a liberal democracy societies have achieved an ideal state of government. This should raise questions as to whether centralisation and increased state control modelled on a Russian model are answers to the challenges that South Africa faces.

Compounding an analysis of the impact of the later development plans of government and the NDP are both State Capture and the COVID-19 pandemic and their disastrous impact on the country. While the latter could be regarded to a degree as a mitigating factor, responsibility for State Capture, however, must rest solely on the shoulders of the ruling party as both during that period and subsequently there has been little apparent appetite from government then and now to address the key issues outlined in the findings of the Zondo Commission. This fact was recently highlighted by the Chief Justice Raymond Zondo.

What can we learn from what has occurred in South Africa since 1994 in the context of the various plans described above? Certainly, many of the promises and undertakings outlined in the various plans since 1994 have proved empty for a majority of South Africans. Five year plans that are essentially driven centrally, while possibly able to achieve some gains, are likely to fail overall to meet their objectives. Similarly a political doctrine that espouses nationalisation and the abolition of what are disparagingly referred to as Neo-liberal policies by some, is equally unlikely to succeed. While I would not support an unbridled free market system I am firmly of the view that the benefits of a more Neo-liberal democracy to all sectors of South African society outweigh the advantages espoused currently by those on the political left when advocating a more socialist and even communist society.

As I have stated previously, I believe that a government that supports and gives effect to a meritocracy free from patronage and prejudice will be the more likely to achieve the “decent standard of living” envisaged in the NDP and desired by all South Africans. Much of what is outlined in the NDP 2030 is excellent but the challenge has been and is implementation. Implementation not by an increasingly centralised government but by the citizens of South Africa. South Africans, many now living in other countries in Africa and elsewhere where they are acknowledged for the contributions they make to the communities of those countries, should feel encouraged to return to do the same in the country of their birth. In that way, rather than increased involvement of government in the everyday lives of South Africans, reduced dependency on social grants and a reduction of the Gini coefficient to 0,6 or less may be achievable.

Probably the most cogent message that I can glean from my limited review of the South African planning process and its results are not so much the nature and content of the various plans, many of which were and are good, but rather the mechanism adopted to implement them. Politicians and bureaucrats at the centre, often without a clear understanding of how or what they are expecting to happen almost by decree at the coalface, will not implement policies and plans. Rigid controls exercised from the centre working through a bureaucracy that in itself promotes inertia will result in failure. I have a fear that the envisaged National Health Insurance (NHI) may fall victim to similar weaknesses. Surely the experience of the Soviet Union and Eastern Europe during the Cold War should have taught us that?

Commissions, task teams, committees and elaborate documents outlining processes do not get things done. As we have experienced in South Africa where a plethora of structures and processes of this nature exist lead to inertia and stagnation. Government should provide an enabling rather than constraining framework. Recently it was reported the President Ramaphosa during his term has created over a hundred commissions, task teams, advisory committees and war rooms to date!  Government functions and is funded through taxation of the initiative of individuals and groups and not on the actions of government itself. This has been starkly illustrated by the failure of public and state enterprises over the last two decades.

What South Africa needs are politicians, policies and plans that provide not only the promise that things will happen but create the environment in which this will occur! I fear that this may not happen in 2024 but as an optimist I live in hope!

  1. South Africa’s Economic Transformation since 1994 What influence has the National Democratic Revolution(NDR) Had? SL Mosala, JCM Venter, EG Bain Rev Political Econ 2017 44:327-340
  2. National Development Plan 2030 Our Future-make it work ISBN: 978-0-621-41180-5
  3. The End of History and the Last Man Francis Fukuyama 1992 Simon and Schuster

A health professional with over 40 years of experience both as a clinician and a senior health manager in South Africa