Health commentary,  Political commentary

Refuse … a marker of government failure

In March 2021 I wrote a post entitled, “Piles of refuse are a public health problem”, and reflected on the causes and consequences of this phenomenon.

18th July 2022 was the annual Mandela Day, a commemoration that is intended to be a “global call to action that celebrates the idea that each individual has the ability to make an impact”. Using the fact that Nelson Mandela fought for social justice for 67 years, people were urged this year to spend 67 minutes according the Mandela Day 2022 slogan to “Do what you can, With what you have, Where you are.”

A video was posted on Twitter by the South Africa Presidency later on Mandela Day of President Ramaphosa wearing a yellow security vest and with red gloves cleaning a section of the Swartkops River in Gqeberha, a city in the Eastern Cape. Using long tongs he almost ceremoniously placed the refuse in a plastic refuse bag. It was insightful that while a few similarly clad dignitaries apparently did the same, they were watched by the media and a large crowd not apparently following suit.The President speaking at the event acknowledged the river was filthy and proposed that the community should take care of their surroundings taking a day every month to “clean up”. According to the President the city of Gqeberha and elsewhere in the country similarly needs to be cleaned up.

Without wising to be unkind, the fact that the river was littered with refuse and as the President admitted so was the city of Gqeberha, is a reality across many cities and towns in South Africa. While this is as a result of people littering and dumping refuse illegally, it is also the result of a failure of local government to fulfil one of their functions which is refuse removal. A single day in a year or even a day in every month will not change the fact that local government is failing in many of its basic functions such as the provision of water, removal of sewerage and solid waste from communities.

I am drawn to the slogan of Mandela Day 2022, “Do what you can, with what you have where you are!” In my view this should be the slogan for government as a whole and not just communities on a single day of the year. At the same event the President spoke about the failures of ESCOM and the lack of safety and security that many communities experience which again pointed to the failure of the government that he leads to ensure that the citizens of this country enjoy many of the basic rights and freedoms guaranteed by the Constitution of this country.

While the President did not in the various video clips posted on the Presidency Twitter feed speak directly of the failures in the health sector, although he did make passing reference to the need to implement National Health Insurance, these are well documented across the country and particularly in the province that he visited on Mandela Day. I have elaborated on this reality in many of my posts over the last two years and witnessed it first hand as a member of various ministerial task teams over the last seven years.

Certainly fraud and corruption during what the President has termed the “nine wasted years” and before, have played their part in determining why we as a country are where we are but this alone cannot account for the sorry state of affairs in many communities only exacerbated by rising inflation and unemployment resulting in poverty and desperation.

As I have argued on many occasions, the key to success in South Africa is developing a competent public service that can create and sustain an environment where economic opportunities can be created, not be government alone, and where a majority can prosper and not just an elite few. This revival could potentially initially be spurred on by large scale, people-intensive, state driven projects, similar to those adopted in  what was termed, Franklin Roosevelt’s “New Deal” of the 1930’s in the United State. I accept that many aspects of the “New Deal” can be criticised, but a similar approach could be a template for interventions to wrest South Africa out of the mire in which the country currently finds itself.

Building on the President’s call to “clean-up” the country these projects could not only ensure refuse does not accumulate in communities with the attendant health risks, but also fix crumbling roads and infrastructure, paint hospitals and clinics, fix leaking taps and broken windows, even construct basic brick and mortar dwellings to mention only a few. This could be achieved by people paid a basic stipend in lieu of their contributions and be positive steps to making South Africa a better place … Doing what we can, with what we have where we are!

Returning to Nelson Mandela, I recall a speech in the initial years after 1994 in which he questioned why those with employment sought increased wages when so many had no prospect of employment even if they were willing to work. While workers should not be exploited, it is ironic that the recent settlement reached with ESCOM workers who engaged on an illegal strike almost paralysing the country with rolling blackouts, gained them a 7% salary increase. This is painful taken together with a Chief Executive of a failing public entity receiving a package estimated to be around R7 million annually indicating that he and senior management would not received any increase in their own remuneration! This in a country where unemployment is over 50%, many people do not even have housing that protects them from the elements and are uncertain from where their next meal will come.

If South Africa is to prosper and the well-being of the population is to improve, the country needs bold, decisive and inspiring action-orientated leadership to take its citizens along a difficult path that will require sacrifices from every one both from those that have and those that have not.

The country has a liberal constitution, so let us live by its liberal principles where the welfare of everyone motivates us and no-one is left behind irrespective of their race, religious beliefs, customs or social status. The time for endless consultation, task teams and more grand plans that fail to come to fruition is long past. It is time for “cleaning up those piles of refuse and getting things done!”

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