Health commentary

The state of South Africa is not good!

As I write this, I am challenged by the state of South Africa today. Echoing the words of an American President, Gerald Ford, addressing the United States Congress in his 1975 State of the Union Address when he memorably told his nation that, “the state of the Union is not good” I would say that “the state of South Africa is not good”. South Africans are challenged daily by failures of service delivery from local, provincial and national government as well as State-owned entities.

As a South African health professional I am particularly concerned by the impact of these failures on the public health service that serves the majority in this country. Failure in the water supply to hospitals in the most populous province of this country, Gauteng have resulted in the closure of some of these facilities. A fire at the Charlotte Maxeke Academic Hospital in Johannesburg resulted in the prolonged closure of the facility, one of the largest in that province. Health infrastructure across the country is in many instances crumbling as a result of lack of adequate maintenance of which the fire at the Charlotte Maxeke is but a symptom. These isolated incidents reflect a much greater malaise that exists within the public health sector. I wonder what Charlotte Maxeke after whom the erstwhile Johannesburg General Hospital is named, a religious leader and political activist and the first black South African woman to graduate with a university degree in 1903, would have thought of the current state of her country and its health services?

Media reports reflect the disastrous consequences of failed service delivery in many municipalities across the country. The result has been water supply that is intermittent and in some cases non existent. Raw sewerage that overflows into streets and the properties of residents and in a city as large as Bloemfontein piles of refuse that litter the streets. In a recent visit to Bloemfontein where I lived for some 18 years until 2001, the once well maintained streets were dotted with potholes and areas of the city were a picture of decay and neglect. Service delivery protests have become almost daily occurrences across the country driven by the dissatisfaction of citizens with their lived experience in this country.

ESCOM is unable to ensure a constant supply of electricity to the citizens of South Africa but rather like the analogy of a frog in a pot of slowly warming water, we have become accepting of what is the serious and disastrous failure of a State-owned entity suffering from the effects of fraud, corruption and mismanagement that has drained billions of rands from State coffers. The Zondo Commission, or more correctly the Commission of Inquiry into State Capture, has ground relentlessly on and on, so that South Africans have, as with ESCOM, become cynical about the revelations day after day of the brazen theft of billions of rands that should shock and enrage.

Most recently State resources have been plundered in response to the COVID-19 pandemic. It seems that moral decay in South Africa has descended to such a level that millions if not billions of rands related to the procurement of personal protective equipment (PPE) have again been siphoned off by unscrupulous individuals seemingly without conscience or shame. Equipment that was intended to protect health workers and others from infection with a deadly virus. Even funds allocated to relieve the disastrous financial impact on the poorest of the poor of the COVID-19 pandemic were not immune for the avarice of others.

While fraud and corruption are a cancer eating at the very foundations of our beautiful country, another is the failure to ensure a meritocracy in those that we appoint as leaders. Given the challenges that this country faces there can surely be no justification to appoint, for reasons other than merit, incompetent and dishonest people into positions of authority in the managerial, administrative and political spheres.

Paradoxically it seems that with time entitlement has grown within an elite seemingly oblivious to the plight of so many of their fellow citizens. On the one hand, author Pieter du Toit describes corporate sector avarice in an entity such as Steinhoff in his book, The Stellenbosch Mafia, while on the other hand avarice within the public sector is reflected by Pieter Louis Myburgh in his book, Gangster State. In both, despite overwhelming evidence of malfeasance, years after the events outlined no-one has been visibly held to account despite many of the facts being known.

So what should be the response of South Africans to the calamitous state of the country?

Without accountability to a moral if not a legal standard, the state of South Africa cannot be good. Accountability must also not only be linked to acts of malfeasance but it must be seen to be done within a reasonable time frame. A consequence must be linked indisputably and publicly to acts of malfeasance. Accountability implemented in this fashion must be the deterrent for those whose moral and ethical standards do not preclude them from acts of mismanagement, fraud, corruption and criminality. Further meritocracy must govern the appointment of people into positions of authority in both the public and private sectors who must then be held accountable to deliver according to the mandate of their appointments.

The good citizen must be praised while competent and committed individuals must receive support when they blow the whistle on, or stand against corruption and crime. They should not, as it seems has been the case, suffer for their actions. I have in my career sadly been aware of honest public servants whose lives and livelihoods have been destroyed solely because they had the courage to stand against what they deemed to be wrong.

In the final analysis, we as South Africans must hold our leaders and each other to the highest moral standards and levels of accountability. We must be intolerant of those whose integrity and honesty is questionable and those who fail to deliver on what they have been appointed to do. Without leadership and a citizenry of this kind, the state of South Africa will remain not good.

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