South Africans have become vegetally preoccupied with the ramblings of Minister of Health Manto Tshabalala-Msimang, on HIV/Aids. As she tosses her mad Greek salad, we have lost sight of the crumbling of the broader health system.
This week, the Mail & Guardian begins publishing the findings of its Âhospital project. We have visited 26 public hospitals across the country and found a system in crisis.
While we all know the individual stories of long queues, taking your own linen to hospitals (if you can afford linen, that is), shortages of essential drugs and the snail’s pace progress of the Aids treatment programme, our investigation seeks to show that the whole public health set-up is teetering on the brink of outright system failure.
The first vector of decay is human. Faced with a flood of people with Aids, in addition to the normal health needs of a developing country, nurses and doctors have fled. This is the overriding theme reported by our journalists as they have trekked from province to province. Hospitals are limping, some on vacancy rates of more than 60%. Nursing shortages are even more acute.
Who on earth decided to close nursing colleges in the late Nineties? This decision, exacerbated by the poaching of nurses by the developed world, has helped spawn the emergency.
We are now in a double bind. Those nurses who have remained are so overworked and demoralised that absenteeism has become chronic.
Yet our journey of discovery was not only one of despair. We met amazing people en route — such as the Pakistani doctor in the Northern Cape who looks like a member of Bollywood’s bling set, but who possesses a lateral mind and a deep commitment to his job and his adopted country. He did a simple thing: he interviewed doctors who were leaving to find out why. They told him they needed to earn more to pay off their loans. He agreed to pay their loans if they committed to the medium term. And the system is working.
A nurse at a Somerset hospital in the Western Cape has killed two birds with one stone. The region is beset with high unemployment while her hospital suffers from the usual nursing shortage. She has found people in the community with basic skills, started a training programme to bring them up to auxiliary nurse level and negotiated with a training school to credit the skills they have and train them as qualified nurses. Bingo.
The nurses stay because they are with their community, and those who leave to study overseas come back.
What these uplifting stories illustrate is that more authority, more money and more influence must be devolved to the level of the individual hospital. At the moment too many decisions are taken (or more accurately, not taken) by provincial departments.
Constitutionally, Tshabalala-Msimang does not have hands-on Âauthority. But she is the leader of the health system — and because she is politically beleaguered, and constantly juggling vegetables and Aids-related crises, she has taken her eye off the ball.
Perhaps it is time to split the portfolio, giving a deputy minister full responsibility for developing policy on the Aids pandemic and on monitoring prevention and treatment. The state of our hospitals strongly suggests the need for a dedicated czar of general health.
And neither of the posts should go to Tshabalala-Msimang …
Democracy in action
It should not need endless restating, but some South Africans still have to be reminded: for all its warts and weaknesses, we have a vigorous democracy. Two events in recent days have highlighted this fact.
The first was the extraordinary spectacle of Tony Yengeni, liberation war hero, a member of the African National Congress’s national executive committee and the party’s former parliamentary chief whip, presenting himself at Cape Town’s Pollsmoor prison to serve his jail sentence for fraud. Yes, he was given a hero’s send-off by a foolish bunch of diehards including Western Cape Premier Ebrahim Rasool. Yes, he may serve less than a year of the four years to which he was sentenced. And, of course, the inefficiency of our law enforcement system lets many powerful offenders off the hook. But the spectacle drove home the point: not even the most senior and popular members of the ruling party can consider themselves above the law. The South African judiciary, one of three pillars of our constitutional democracy, cannot be brushed aside or overridden at the whim of politicians, as it can in Zimbabwe.
The second cheering event was the Constitutional Court’s invalidation of a range of laws last week — including the controversial Twelfth Amendment Act, which scrapped cross-border municipalities — on grounds that Parliament had failed in its constitutional duty adequately to sound public opinion. As the laws will remain in force for 18 months to allow the legislators to take remedial action, this will not make any immediate practical difference. But it was a salutary reminder to MPs that ultimately, they are accountable to the mass of ordinary South Africans.
The ruling holds out at least a gleam of hope that the African National Congress in Parliament will rethink the unpopular twelfth amendment, which has triggered popular upheaval in some areas that is reminiscent of the late 1980s. But the overarching message is that South Africa is a rechtsstaat in which every person and institution, including Parliament, is subject to the Constitution.