/ 27 August 2025

South Africa in ICU: A patient in need of treatment, not more consultations

Graphic Ca Khaya Serum Twitter
Graphic: John McCann/M&G

Psychologists tell us that children begin to distinguish right from wrong as early as the age of six or seven. In South Africa, the legal age of responsibility is 18 and science has shown that full cognitive maturity develops at about 25 years of age. By these standards, South Africa, at 31 years into its democracy, should be a fully mature adult, capable of making rational choices and holding itself accountable.

Yet, if we were to imagine South Africa as a medical patient and its citizens as the diagnosticians, what we find is deeply troubling. Despite having passed every stage of cognitive development, the patient continues to fail the most basic tests of accountability and transparency. 

The government’s recent proposal of a National Dialogue, costing R700 million, has been presented as an opportunity to help the nation reassess its moral and political direction. At face value, it appears to be a good-faith attempt to bring people together. But, when we look deeper, the prescription seems flawed. 

During the 2024 national elections, political parties collectively spent well over a billion rand on campaigns, claiming to have the answers to South Africa’s ailments and having consulted the people. If such vast resources failed to produce a meaningful diagnosis, how then can we expect talks on a smaller budget to magically reveal what is wrong? 

The concern is not only about the financial implications of this dialogue. It is also about the medical history of South Africa as a patient. Over the past three decades, the nation has undergone several consultations, diagnoses and treatment plans. These have included commissions of inquiry into state capture, the Phala Phala scandal and the Marikana massacre. Similar to a patient repeatedly being prescribed life-saving medication, South Africa was offered antidotes in the form of recommendations. But, year after year, those prescriptions have been ignored or taken half-heartedly. 

The result is that the symptoms persist and the illness worsens. Recently, South Africa was presented with what were described as “explosive” claims from the KwaZulu-Natal police commissioner, Nhlanhla Mkhwanazi. What was the antidote to that? A commission of inquiry. 

South Africans are left to ask: “How will this consultation, this National Dialogue, be different? What guarantees are there that, this time, recommendations will not simply gather dust on government shelves?” Without an honest answer, the proposed dialogue risks becoming yet another costly consultation with little to no recovery in sight. 

Will it be that an exorbitant amount of effort and money is spent on ethnographic research which displaces the realities on the ground, attempting to inform accurate policy formulation? What more do you have to talk about when the panacea can be found in existing policies that are not implemented?

This is not to say that dialogue is unimportant to the project of democracy; public participation remains an imperative cornerstone of our democracy. Every patient deserves to be heard and every diagnosis requires listening. But listening without follow-through is a dangerous placebo. What South Africa urgently requires is not another round of polite conversations, but a programme of bold and decisive reforms. The patient is in the intensive care unit and the time for gentle monitoring has passed.

Treatment must include the retirement of the old and recycled politicians who continue to dominate the political landscape without offering fresh solutions, who sleep their way through meetings. It must also involve the creation of uncompromising accountability mechanisms that hold leaders to their promises and punish corruption without fear or favour. Most importantly, it might require a fundamental restructuring of our system of governance so it becomes one that prioritises transparency, responsiveness and genuine service to the people.

The metaphor of South Africa as a patient is not simply rhetorical. It reflects the lived reality of millions of South Africans who experience unemployment, inequality, poor service delivery and widespread corruption as daily symptoms of a failing body politic. To them, the National Dialogue cannot be another diagnostic exercise; it must be the beginning of real treatment. 

This programme should inspire good governance, economic growth and development. It should be the beginning of the end of articulations such as, “Ke tswa kasi ntwana” (I am leaving, child), the beginning of the end of the apartheid legacy, the beginning of employment for young people. 

At 31 years old, South Africa should be in the prime of its life. Instead, it finds itself in critical condition. The patient’s survival will depend, not on endless consultations, but on the political will to implement real, lasting reforms. Anything less will be to watch the patient fade, knowing the cure was always within reach. 

Dimakatso Manthosi is an independent political analyst and researcher. Neo Letswalo is a research associate at 4IR and Digital Policy Research Unit, University of Johannesburg.