Submission to the
National Health Committee & the
National Department of Health

Submission by:
S Mbara

University of Cape Town
Cape Town

Cell: 078 376 0385
louismbara@gmail.com
mbrsiw001@myuct.ac.za
14 Bedford Road
Observatory
7925

In personal capacity as member of the public and a student in policy development

For National Health Bill 24-2011 Consultations
2012
Cape Town

Notwithstanding the arguably convenient ways through which South Africa practises policy development and judicial development – I would like to mention aforehead of my presentation that I am bringing along with me untraditional avenues of dealing with policy development. I stand here with a strong conviction that new brooms sweep cleaner. It only matters how we sweep with them. I therefore make a plea that everyone pulls out their microscopic lenses and join me in the intensive, core-focused, and processes critical interactions and move with me beyond the traditional ways of working with and for policy and laws development.

I share with President Zuma in saying that policy and judicial reviews are imperative, although found controversial by some. It is indeed true that although our policies and laws may look “beautiful” if we do not configure them to qualify our society and cultures – hey pose beautifully exorbitant chances f loosing relevance when read with our contemporary South African community.

South Africa is currently sitting in a position where most inadequate and or poor service deliveries are due to politicisation of executive employments and in some cases improper application of the affirmative action and employment equity policies. As we proceed here today we are awaited by headlines of what is to happen with the allegations levelled against General Bheki Cele after he was relieved from duties as the national commissioner of the South African Police Services by president J Zuma on the 24 October 2011. In the previous financial years (2008/09, 2009/10, 2010/11) most of our parastatals (including Telkom, SABC, SAA, PANSLAB and others) were all facing similar charges of irregularities and poor performances due to irregular techniques that are sometimes employed during appointment of executive and management officers. 

South Africa seeks to afford all citizens quality health care hence we are looking at better ways through which the major National Health Insurance will be employed. Ultimately it becomes imperative that we develop good habits and expose ourselves, the state’s preparedness and public health administration to the adequate and sustainable trics at the very infancy stage to the NHI. The stage begins with how we remodel  and re-engineer our appointments procedures not only for senior executives but also for all the key personnel in public health. Many hospitals in our mostly rural provinces are already in appalling conditions even though some of them enjoy the status of being regional health facilities serving millions of people such as the Cecilia Makhiwane Hospital & Frere Hospital complex in East London. 

Chairperson please allow me to elude how these rather unwelcome circumstances tie into this bill we are dealing herewith today. My interests come exclusive with section 79A of the national health bill introduced in 2011. This deals distinctively with the appointment of executive officers of our public health institutions. Subsection 79(1) provides that “the minster must, subject to the laws governing the public service appoint a fit and proper and suitably qualified South African Citizen as the Chief executive officer of the office”.  If one takes a critical look at the functions of the aforementioned prospective candidates in advancement of our health institutions - this subsection does not really pay fair attentions to the limits that our minister may have in terms of appointment of a “suitably qualified” officer. 

This does not undermine the constitutional mandate of the health ministers to appoint executive officials but it is critically sensitive to the challenges that are involved in the appointment processes. Of course, there is a consultancy prior announcement of sucesful candidates – but these too have not proved to be useful, they are often expensive and not entirely sustainable. There is a plethora of case studies with which one can explore these and the extents they have from the departments and or SOE where they are hosted to public/state organs cooperations.

Secondly, knowing how unacceptable the appointments have always been conducted and the horrible results they show at the end of the day - I suggest that the national committee considers employment of private services and only afford the minister to approve and select one from a list of recommendations made by a private company. 

It is not helping avoiding utilisation of private sector services where we know they can deliver far better than the public service can do. I provide this reason chiefly because dishonesty and sometimes crime coupled with fraudulency have assumed new identities in the eyes of Auditor General: They have become “irregularities” as well. Here is why; every now and again, we hear of irregularities and unqualified reports or disclaimers confirmed upon our parastatals and departments by the Auditor General – they always boil down to one or combination of two or more of the following:

•	Improper applications of Affirmative Action and Employment Equity

 In the past there have been quarrels about the appointment of inadequately skilled persons in the management of public hospitals. This does not only happen within the public health sector – it is becoming a culture across government departments and SOE which we should do away with before it is too late. I suggest and plead with the national committee that they, along with this bill revision, include strict regulatory terms that will pronounce upon appropriate processes to be followed by whoever is delegated the mandate of screening and appointing senior management in the public health institutions. Case in point – the frail management of Mannenberg Hospital, JF Jooste, Frere Hospital and Madwaleni Hospital in the former Transkei area are few examples amongst many other extremes that I did not list here. 

•	Unfair discrimination against qualified & experienced candidates on basis of perceived threats and “filling-of-quotas”.

This is another problem that needs an exclusive, new and highly energised address. Employment equity needs not to be a threat to the stability of our state, governance mechanisms and a poking-stick to the legality of our health institutions’ establishments. The current case of the correctional services officers acting against the state in the appointment of regional commissioners in the Western Cape region has got a legal standing that is so valid, substantial and thus posing threats to the state. The state in cases of this nature is occupying a position that is subject to unnecessary loss of funds (legal consultations, litigation). The basis here is employment equity going wrong at the expense of filling quotas.  Qualified and experienced incumbents are ignored because of their race – that the only aggravating factor acting against them which is certainly an ironic mitigation for them in the judicial view. Let us be cautious not to forgo the premises of our constitution.

•	Politicisation of executive administrative positions 

•	Ignorance of reputation check on candidates and incumbents in office.

Chairperson, it cannot be right to employ people who we know are incompetent or people whose reputation include maladministration of funds and company/organisational resources from their previous employers, whose leadership qualities  are bearing no desirable fruits to the employers and the end-user of the services which they are to be entrusted to champion. 

A country that is running its administration and parastatals would be the one that keeps the national public prosecutor at bay by doing the right thing, the right way and at the right time.

It may also be advisable that instead of privatising the whole processes the portfolio committee revises and redesigns creatively a system that will ensure transparency but undertaken by a private company. I will be very glad to see that happening in South Africa where business is complimentary between public and the private sector without it being conditioned by racial undertones.

I wish to congratulate the committee on the revision of the functions of both the executive officer and the ombud as per bill 24-2011. What worries me however is the extent to which the ombud will be accessible, relevant and acknowledged by our clientele in the public health institutions. The bill is silent on this crucial part. Without this being simplified in very much in unambiguous terms we will be embarking on a journey that will provide us with all the reasons to spend the tax payer’s money aimlessly. 

Ultimately I make this suggestion to the national committee to go back to the drawing board and come up with a plan that will provide adequate address as to how will the Ombuds will be accessible and bring their relevancy to the society that they will be serving. We should always remember that before bills as well as amendments – we have a standing constitution upon which we must draw our policy developments. In that view, until it can be proven that there is accessibility of the ombud and its well arranged functions in this bill we are actually cheating the public and ill-spending on their tax contributions.

Contrary to the popular belief, management of health institutions is rather a personal job. Social anthropological studies provide how inextricable is the person working effectively in the public health institutions with what they are doing. With this view – experience, occupational ethics and reputation checks are more crucial for our Ombud in the public institutions.

Serious understanding of the PFMA & the Executive ‘couch’.

We further more need to make sure that those appointed by the state to serve in senior executive position have a proven record of understanding and experience of with and within the parameters of the PFMA.

There seems to be a carrying culture of knowing what the Public Financial Management Act says. In most cases, executives take comfort in just knowing and never mind about developments within the act. This is an area where there is no evidence that the recruitment mechanisms that we have in place tap on. The bill before us today does not pronounce on the magnitude of ensuring individual’s conduct in respect to the PFMA. 

More often than not, bills that only focus on what should be done and entirely leave out the “hows” and meanings are not helping anyone. We are, as a result, faced with the challenge of letting go executives who administrate state funds and resources illigimately without being ‘called to book’ and accounting for their wrong doings adequately. 

This has to stop. We cannot afford to defer this anymore. It is accumulating a status of being emergency if it has not already. Executive officials in public administration  take comfort in swiping at Nandos, fuel stations for their friends and families as well as splurging in luxury at the likes of One & Only and Mount Nelson classes at the expense of the state without observing the PFMA. They know it will cost them nothing and their respective departments AGs “DISCLAIMER” stamp or be rendered as irregularity.

In Conclusion,

I congratulate the decision to develop our policies in the critical field of public health. For a long time we have been plagued with laws that did not assist the state and the public in achieving the standards we always wished to have. Service delivery in the public health institutions is heavily retarded by poor executive management and executive administration more than it is by the persons practising on the ‘ground’. It is high time that we realise the need to amend for the better health that we have always been anticipating.

I believe that unless we unlearn the traditional way of developing our policies – we stand better chances of actually undertaking developmental strategies that are entrenched in social, economic and health development, that are easy on our budgets and fair to the tax payer. It begins with inclusive governance attitudes. I am merely calling for systems that will afford us the chances of avoiding unforeseeable and exorbitant costs

While I am on the endorsement of the bill – I would, notwithstanding that fact, plead with the committee to initially look deeply in the submissions that we make here today and consider them on basis on process and end-user attitude view. According to my view, it pays only sorrows to aim for good results where there was no integral focus, investment and proper care of the processes and ideal result models. Focus on outputs should and must follow proper design of processes and adequate assessments thereof. 

We need to be sensitive sometimes especially when it comes to management of critical service delivery to the public. The concerns of the public are, as most academic research explores, not always taken seriously. This should not be confused with saying that the public is never consulted. The issue here lies with how do authorities deal with complaints from the public. In most cases – the working class and the poor urban and rural people are the usual victims of this phenomenon that is gaining a disturbing momentum that acculturates it into our public sector management structures across all governments departments. Some very clear cases, and most often ignored in their phenomenology would include, amongst many others; the Mazibuko Case of the people of Phiri in Johannesburg or the investigation of how was the social organisation “Abahlali baseMjondolo” was composed upon and least but not last – The Mapgo-a-Mathamaga security: the way through which this social neighbourhood watch became vigilantised by our legal systems. I do not argue that they were not but the way through which our authorities dealt with poor urban people’s complaints can turn things around. These often become too expensive for the state.

Before we begin to think that these are far fetched – I would like to draw you attention to the recent effects of the so-called xenophobic attacks (specifically min Alexandra, JHB), the burning down of clinic and libraries in the Mpumalanga province and the allocation of doctors and infrastructures to peri-urban and rural areas across the country. 

From the public health perspective – people with expertise in handling complaints without any political bias would have been able curb the extent of damages. Adequately skilled executive officers in public health institutions would be able to strategise allocations, incentivisation and distribution skilled doctors and hospital managers to address human resources backlogs as well as infrastructural challenges in the rural and peri-urban areas. 

In the case of managing public health institutions and facilities in developed cities such as the case of JF Jooste, Cecilia Makhiwane, Frere and King Goodwill Zwelithini Hospital and many others – the case remains highly politically motivated hence I referred to uprooting of politicisation of executive appointments, prioritising AA and EE quotas over skills, experience and the matching of the Key Performance Areas with the appropriate candidate. 

Let us invest energies in creating ombuds that will be fairy accessible and be able to address complaints without bias on basis of class, political affiliations, race and gender.

Thank You.