The time is now for change!

I trust also that the reader will agree that given my background, which I will elaborate on elsewhere on this website, I have no desire to make political capital out of any comments in this regard.

So what is my assessment of the position South Africa finds itself after 100 plus days of varying degrees of “lockdown”? As I write Gauteng has for the first time the greatest number of positive COVID-19 coronavirus tests in any province as well as having the largest number of active case of any province. This is a trajectory that is closely followed by the Eastern Cape. The Western Cape long designated as the “epicentre” of the COVID-19 pandemic in South Africa is showing a slowing of both the number of positive cases and the number of deaths although the province still has the dubious record of the most COVID-19 related deaths of any of the nine provinces. A recent press release from the Premier of the Western Cape has reported that a hold has been placed on the opening of additional beds at the field hospital located in the Cape Town Convention Centre (CTICC) as projections in that province indicate that the beds will not be required.

In contrast the Business Day of today, 9th July 2020, reports that Eastern Cape and Gauteng faces dire bed shortages and that the National Health Minister in an address to the National Assembly stated that “the storm we have constantly warned South Africans is now arriving” and that the “currently planned hospital beds in the Eastern Cape and Gauteng are projected to be insufficient” A report in the Financial Mail echoes similar sentiments in a report “Bracing for the Storm” with the additional fact that the NASREC field hospital in Gauteng is not equipped with oxygen which has been shown to be life saving in the treatment of COVID-19 patients. As a result the Gauteng Premier has indicated that “oxygen will be added to the NASREC field hospital”. The report also indicates that many hospitals in the Gauteng province are not adequately prepared, having not effectively used the time offered by the “hard lockdown”.

This has lead to calls for the reintroduction of a hard lockdown albeit in the affected provinces and a reintroduction of the ban on alcohol sales in an attempt to reduce the trauma burden on already overloaded hospitals. South Africa imposed one of the hardest lockdowns at a very early stage in the pandemic in this country and persisted with prolonged and at times apparently illogical restrictive measures imposed on citizens with a drastic negative economic consequences for so many. However it now appears that in Gauteng, the Eastern Cape and possibly other provinces this has not achieved the desired outcome. The message was that “flattening the curve” would grant the health services the opportunity to prepare for the “storm” to which the Health Minister has eloquently referred. In fact in the case of Gauteng where the rapid increase in infections is a relatively recent development, the authorities have had over 100 days to prepare and yet if the reports are even partially correct, this has not been achieved. Why is this so? What were the responsible officials doing during the last 100 days if provinces such as Gauteng, Eastern Cape and possibly KwaZulu-Natal face the crisis that is being reported?

It is easy to blame the citizenry for failing to limit the spread of the virus by adopting measures to decrease the spread of the virus but the increase now being experienced in Gauteng was predicted by the modelling of epidemiologists and public health experts advising the government so this cannot be used as a justification for the predicament in which the authorities in Gauteng and the Eastern Cape now find themselves. I would suggest that the honourable step would be to admit that the authorities in these provinces have failed to do what they should have done and now make every effort to address the shortcomings. Later, however, those responsible for the dereliction of their duties must be held accountable for their failure to act appropriately.

My experience of health care in the provinces points to an underlying, systemic lack of capacity that has only been worsened by the pressures created by the pandemic. The provision of effective health services is a managerial and administrative process that requires systems and processes backed by competent and dedicated people (public servants) to provide health staff with the environment within which they can deliver quality health care. The Report of the South African Lancet National Commission released in 2019 points to what are referred to as gaps in ethical leadership, management and governance in the South African health system contributing to poor quality health care which in turn is linked to increased mortality and morbidity. Sadly then the current situation should not surprise observers as the public health services have been allowed to be held hostage to incompetence, ineptitude, political largesse and even fraud and corruption over years and the country is now reaping the fruits of this neglect in the midst of the pandemic. I have previously called for an urgent health compact, a call that was echoed in the Report of the Presidential Health Summit held in 2018 and I would urge that the time for further investigations, task teams and the like is past. What is needed is action with concrete steps to ensure that competent and professional public servants are given the space and resources without political interference to correct the deficiencies that have been repeatedly identified utilising the capacity that is available in the country in both the public and the private health sectors. The time for talking is past, the time for action is now!