Accountability can be reflected by an action as simple as stooping to pick up a sweet wrapping that one has inadvertently dropped rather than walking on and leaving it for another to clean up. Accountability is reflected by the driver of a motor vehicle who slows and brings his vehicle to a stop as the traffic light turns from orange to red rather than hastening through when it has already turned red risking an accident. Simple acts, but both have consequences for which there is individual accountability.
In September 2020, almost at the inception of this health blog, I wrote for the first time on more serious aspects of accountability related to healthcare and the “COVID-19 pandemic”. Since then the world has moved on from the challenges of the “COVID 19 pandemic”, an episode in history about which some of the actions taken at the time by those in authority could be argued worsened its consequences.
What I wrote in 2020, I feel bears repetition, and that is that accountability as defined in the Merriam-Webster dictionary is “the quality or state of being accountable i.e. an obligation or willingness to accept responsibility or to account for one’s actions”. My professional training as a doctor made me aware of my accountability for my actions as a health professional. As a university lecturer I taught my students aspiring to be doctors and medical specialists that once they had accepted responsibility for a patient they were accountable and could never leave the patient if the diagnosis and the treatment was unresolved without handing over that responsibility to another. This applied whether or not they had other commitments, pressing or otherwise. I believe the same level of accountability applies equally to everyone, be they a doctor, artisan or executive, who by their position accept responsibility whatever that may be. Failure to fulfil that responsibility renders them accountable for their failure to do so and liable to the consequences.
A full-scale war started by Russia in 2022 rages unabated in the Ukraine destroying the lives and livelihoods. In 2023 another chapter in the relentless conflicts in the Middle East begun with an act of senseless brutality in 2023 continues in the Gaza Strip. Those responsible for starting and continuing conflicts of this nature are seldom, although there are notable exceptions, held accountable for their actions despite the pain and suffering that results.
In South Africa the political landscape altered dramatically in 2024 when no clear majority was achieved by any political party resulting in an uneasy coalition euphemistically termed a Government of National Unity (GNU). Subsequently the politics of this country, despite the country’s many pressing challenges, have been characterised by a lack of unity rather than the reverse. Leaders seem ready to score political points off each other rather than accepting collective accountability for the responsibilities they have been given by the electorate.
Recently while traveling with family in Johannesburg I experienced what is colloquially known as the “blue light brigade”. This describes the manner in which highly placed officials travel from place to place. In two instances traffic was completely halted across a three lane highway to allow around ten luxury black SUV’s with two motorcycles in the lead to pass through at high speed and disappear into the distance while inconveniencing hundreds of people. Did those occupying the luxury SUV’s of the “blue light convoy” on their way to what one presumed must have been very important engagements accept accountability for, or even think of, the consequences of their actions.
Across Johannesburg, which should be a thriving city as the economic hub of South Africa, I witnessed distressing signs of urban decay. Johannesburg infrastructure has deteriorated to an alarming degree particularly exemplified by the numerous dangerous potholes on public roads. A good friend, who like me spent many years in Bloemfontein, after a recent visit to that city lamented in a conversation that similar conditions exist there and residents are forced to seek relief from a failure to remove household refuse, dangerous potholes and defective street lighting by engaging private contractors. In my travels as a member of various health and finance related task teams over the last few years, I have experienced similar urban decay in towns across various provinces. Who and where are those who should be held accountable?
It appears that to an increasing extent we are prepared to accept the lack of accountability that pervades our society. Education is loath to address underperformance allowing a student to graduate with a passmark of below 50% although the converse is that they are ignorant of more than 50%. In the work place supervisors fail to address underperformance for fear of the reaction from their subordinates. It is deemed “acceptable” by authorities that the elderly are compelled to wait in long lines, at times unsuccessfully, to receive their pensions or as happened most recently to have their pension cards renewed. We may complain bitterly on social media and elsewhere but how many of those responsible are held accountable for their actions.
I would argue that the first step is to accept personal accountability for the manner in which we act. Accountability needs to come from within each and every one of us and not as a result of compulsion by laws and regulations. Just as if we stoop to pick up that sweet wrapping if everyone is prepared in their actions to accept accountability the world around us can only become a better place. Accountability that if a student fails to achieve a 50% passmark in an examination he or she has failed to do achieve what is required. Accountability that if potholes dot the streets and refuse piles up that a municipality has failed to achieve what is required. Accountability that if a patient is forced to lie on the floor of an emergency unit that the health service has failed to meet its basic requirements. When and if accountability is accepted then consequences must follow. The student with a mark under 50% will have to repeat the examination, the municipal manger or hospital CEO must address the shortcomings in their organisation or face disciplinary sanctions as a consequence.
Accountability is simple in its definition but far reaching in its implications. Accountability should become a central tenet of our society. Within that acceptance lies the seeds of the successful society in which we would all wish to live!
