The Life Esidimeni tragedy happened in the early months of 2016 when a long-standing contract with the Life Healthcare Group was terminated by the Gauteng Department of Health. Thereafter despite warnings that this was unwise around 1500 vulnerable mentally retarded patients were transferred from Life Esidimeni facilities in Gauteng to Non Governmental Organisations (NGO’s) in what was known as the Marathon Project. Many of the NGO’s did not have the capacity or resources to manage patients of this nature and as a result at least 144 patients died of neglect and many more suffered inhuman and degrading conditions. This occurred less than a year after I had retired as Head…
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Government of National Unity (GNU) … illusion or reality?
The May 29th 2024 election delivered a parliament for the first time in the 30 years since 1994 in which no single party had a majority. During the past 30 years the African National Congress (ANC) had a significant majority at both national and provincial level with the exception of the Western Cape province where since 2009 the opposition Democratic Alliance had a majority which was maintained in the 2024 election. Clearly after the 2024 election the ANC which was the largest party with just over 40% of the votes had to seek coalition partners. After tough negotiations a coalition was formed with the Democratic Alliance as the second largest…
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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…
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Thoughts after recent travel outside of South Africa …
I recently had the privilege to travel to Scotland, Austria and Germany and while this post is not directly health related the connection to good governance and government on which effective healthcare delivery depends is clear. In Scotland my wife and I visited my daughter, son-in-law and two grandsons on the croft in the Scottish Highlands that they purchased shortly after their arrival in Scotland over three years ago. In the last 18 months the family have constructed a barn on the property without outside assistance, something that they would have been unlikely to undertake in South Africa. Crofts which are a feature of the Scottish Highlands established in the…
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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…
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André de Ruyter … Truth to Power … a must read!
I have just finished reading André de Ruyter’s book Truth to Power My Three Years Inside Eskom, which I believe should be read by South Africans interested in why the country is the way it is today. Unlike de Ruyter, I spent my whole professional life in the public sector, while he entered Eskom as the CEO having only worked in the private sector. He acknowledges that he completely underestimated the constraints imposed on him as the Eskom CEO by the public service regulations and processes as well as political oversight. As with de Ruyter when I moved from a clinical role in health services into management in 1994, I experienced…
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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…
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Is the state of South African public health a budgetary or a delivery problem?
I was struck recently when according to a news report the National Minister of Health had appealed to his cabinet colleague the Minister of Finance to “stop cutting health budgets” and in doing do “alleviate the pressure on frontline health services”. He indicated that he had requested that there be no budget cuts in the coming year as had been indicated previously, so there would be no further reduction in frontline services. As an illustration the Minister reported a large number of vacant posts in the Free State Health Department of which the province had indicated nearly 900 were termed as “critical frontline posts” which he attributed to a lack…
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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…
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Echoes of State Capture and moral decay … a health perspective
Athol Williams’ Deep Collusion 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…