The Constitution doesn't allow Motsoaledi to give health MECs direct instructions, but his "political influence" would help a great deal.
Doctors, health activists and policymakers are starting to lose faith in health minister Aaron Motsoaledi’s ability to fix South Africa’s dilapidated public healthcare system. They believe he has a “lack of political influence” in his dealings with provincial health departments – which are falling apart.
This week, the Mail & Guardian visited Dihlabeng Regional Hospital in Bethlehem in the Free State. Today the hospital has only a third of the number of doctors it had in 2012. Nurses are resigning in droves because of horrific working conditions. The bodies of patients who have died are left for hours in hospital beds, because there is not enough staff to remove them.
Ironically, Dihlabeng is situated in one of Motsoaledi’s National Health Insurance (NHI) pilot districts, which benefit from a special fund to improve infrastructure and health services. But a group of Dihlabeng’s doctors who spoke to the M&G warned: “The Free State health department is killing the minister’s dream of an NHI. We are concerned that he doesn’t have a clue of what is happening here. We haven’t seen any of the money.”
Last year, the Free State health department was placed under the administration of the provincial treasury because it was no longer considered fit to manage its own budget. But it doesn’t stop with the Free State. From 2013 to 2015 the Limpopo health department was under national administration, because suppliers had not been paid. From 2012 to early 2014, the Eastern Cape health department was under the partial administration of the provincial treasury department for the same reason.
The Constitution doesn’t allow Motsoaledi to give health MECs direct instructions. Yet, argue activists and policymakers, “political influence” would help a great deal. “If the health minister had enough political clout to negotiate with the premiers of provinces to replace MECs who fail to perform their duties properly, and assist them with new appointments, there would be a considerable improvement in health services,” one activist said. “All that he does is to send in short-term national health department task teams.”
Doctors and activists complain that Motsoaledi’s attitude towards them has recently changed from being “the most accessible minister in the country” to “someone who no longer wants to talk to us”. In January, doctors from Dihlabeng wrote to Motsoaledi about the dire situation there, pleading for help. Two months later, he hasn’t responded.
Motsoaledi is a rare breed: a minister with exceptional vision. But unless he drastically intervenes in the health systems of provinces, his vision will be undermined and ultimately paralysed by incompetent administrators who will make his long-awaited NHI no more than a piece of paper.