A recent headline in the Daily Maverick read as follows, “Child malnutrition in the Eastern Cape qualifies as a disaster” quoting from a South African Human Rights Commission report on child malnutrition in the Eastern Cape province. The article cited the fact that 25% of the provinces’s children have stunted growth and over the period of one year over 1000 children were diagnosed with severe malnutrition of whom 120 died. Juxtapose this with a more recent media headline in a Afrikaans National Sunday Newspaper which reads translated from the Afrikaans, “You cough up R24 000 per head so that Cyril’s (the State President) guests can feast while they fly”. The…
-
-
Accountability … is it a reality or a myth?
Reading various media reports about the actions of individuals, politicians, state entity and government representatives, I am struck by how often the word “accountability” is so easily and even glibly used. How often do we hear that a particular person must be held accountable for their actions and how often in the end does it appear that they were not? Accountability is simply defined as an “obligation or willingness to accept responsibility or to account for one’s actions”. It is the state of being accountable, that is being subject to giving account which implies being able to “explain or to be answerable for one’s actions”. In a political sense government…
-
Healthcare … a victim of a self-inflicted government funding malady?
Various questions trouble me when I hear that a public sector health department has a major shortfall in the budget allocation that will result in people being unable to receive the healthcare that they need. Who is accountable? Who is responsible for the consequences? Is it immoral that the cost of healthcare should limit access? Who should decide which treatment should not be provided? What is an acceptable package of healthcare? What can be done to alleviate the problem? I could go on … I have great empathy with a doctor who although the treatment plan is clear must inform the patient that due to affordability constraints that either a particular…
-
Oversight and governance versus Management
Recently pronouncements by both the Minister responsible for electricity within the national cabinet and the chairperson on the Eskom Board drew to my attention the differences between oversight, governance and management. In both cases they appeared to make statements that in my initial thoughts belonged with management rather than a politician and a board chairperson. It is often a sensitive issue when management is faced with a managerial politician or a board that seeks to take management decisions. Eskom, in South Africa, is a State owned entity (SOE) (also defined in the the Public Finance Management Act as a Major Public entity) that provides almost exclusively the electricity that powers the national…
-
Elected politicians and appointed public servants … at times a fraught relationship!
Mr Dominic Raab, the United Kingdom Deputy Prime Minister and Secretary of State for Justice resigned recently. The reasons for his resignation highlight the at times fraught relationship between an elected politician and appointed public (civil) servants. Mr Raab was alleged to have bullied and humiliated officials in various ministries. Bullying was defined for the purpose of this inquiry as follows: (1) Offensive, intimidating, malicious or insulting behaviour; or (2) Abuse or misuse of power in ways that undermine, humiliate, denigrate or injure the recipient . The inquiry, conducted by a senior British advocate, Adam Tolley KC, tested the allegations against the 2019 version of what in the United Kingdom…
-
When is enough, enough?
As a health professional and health manager, it is understandable that most of what I write about is health related. But I am also a citizen of this country and live some of the realities that South Africans experience, albeit not fully experiencing what my less fortunate fellow South Africans experience. For this reason I reflect here, accepting that I am a privileged citizen of this country, on the general state in which South Africans find themselves. Whilst the abolition of apartheid removed discrimination on the basis of race, we are still a country divided along racial lines between those who have and those who have not. South Africans are…
-
Management decisions right or wrong must have consequences.
Recent experience with almost month-long power cuts in South Africa due to inadequate generation capacity have highlighted a State-owned entity has been unable to ensure a reliable source of electricity to the country for over a decade. When this first occurred in 2008, I was heading the Western Cape Department of Health and as management we had urgent meetings with officials from the power utility to decide how to manage what was envisaged then to be a short-term problem. At that time many health facilities had inadequate or no back-up generators and a decision was taken and actioned urgently to acquire and install generators at as many facilities as fast…
-
A personal reflection …
I have not posted anything since July 2022. This is not because there has been nothing worthy of comment in the health sector but rather that I have felt a deep sense of despair with what has transpired in the preceding months and years. Since my retirement in 2015 I have been involved in various initiatives to address challenges in the South African public health service as a member of nationally appointed task teams and most recently as a consultant requested to address financial management in a South African provincial health service. Whilst I accept that as an outsider and consultant not directly responsible for the management of health services,…
-
Accountability … measuring performance
A recent post elicited a request, “Please share your thoughts on how you see the importance of performance data in accountability”. I make no claim to have expertise in the theory and science of performance management but accountability is undoubtedly linked to measures of performance. As is my wont, I went to the dictionary for the a definition of the verb, “account” and found “to furnish a justifying analysis or justification”. It follows thus that accountability is the state of being accountable i.e subject to giving account. In my initial post I had listed accountability as a characteristic of good governance. I used the word more in an ethical sense…
-
Endless meetings and Life … Reflections on a poem
The poem translated from the original Portuguese is attributed to a Brazilian poet, Mario de Andrade, although there is some doubt if he was the author as there is indeed regarding the title of the poem, “My Soul has a Hat” “I counted my years and realized that I have less time to live by than I have lived so far. I feel like a child who won a pack of candies. At first, he ate them with pleasure, but when he realized that there was little left, he began to taste them intensely. I have no time for endless meetings where the statutes, rules, procedures, and internal regulations are…