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06 May 2020 | Story Dr Ina Gouws | Photo Supplied
Dr Ina Gouws

The President of the Republic of South Africa made another address to the country on Thursday 23 April 2020, indicating that the country will enter a phased approach out of lockdown in the coming months. This announcement was met with positive feedback not only nationally, but internationally. It was clear that the President consulted with many experts and also with opposition parties, which indicated that an ‘all-hands-on-deck’ approach was followed across party lines and varied interests. The plan seemed rational, well thought through, and clear: 
 
Support for lockdown
The government’s lockdown and subsequent restrictions on movement, trade and industry held wide support until now. The argument that people’s lives are most important and that the prevention of the spread of COVID-19 infection must be a priority, was accepted as rational. Truth be told, this strategy was entirely reliant on public trust and cooperation, which the President did have at the start of the lockdown. So, when he announced that the country would enter Level 4 from 1 May 2020, there was a sense of relief that progress was being made and that sacrifices made by all of us (some much more than others), have yielded some positive results. 
However, there was also an almost immediate realisation that this approach would have to rely on state machinery, especially on provincial and local levels, which – before the lockdown – was ineffective, to say the least. State capacity had been gutted by widespread corruption, incompetence, and the inability or unwillingness to hold to account those who are guilty of mismanagement and corruption. Add to that the planned deployment of more than 70 000 South African National Defence Force (SANDF) troops in our midst, as well as very little detail on how the R50 billion relief fund will be applied, and most importantly, how oversight over the spending will work. 
Cynicism is good 
This cynicism is being criticised as being uncooperative and that South Africans should only be proud of how government has met the challenges of this pandemic thus far. It is true that in the context of the country’s reaction to the pandemic, this government has done much better than most across the globe. The larger context of governance realities in the country cannot be ignored though. 
I was reminded of certain elements of the value of cynicism in an article by JR Macey. The article was written in the context of USA politics, but there certainly are touch points with South African politics. He basically argues that cynicism is good, and that people should be more cynical when it comes to politicians, officials, lobby groups, etc. As people, we are looking for leadership and sound decision-making. We expect good governance from the government. As South Africans, we have been consistently disappointed with our government in this regard for decades now. When it became clear that this virus was spreading across the globe like wildfire, we naturally held our collective breath. How will a government that can hardly keep the lights on or provide safe drinking water and whose public healthcare system has all but collapsed, deal with this virus when it finally arrives? All valid questions. We were appeased when the President announced a planned lockdown not long after the first cases were reported. We were impressed with the leadership from the Minister of Health and the experts he surrounded himself with. Rightly so. The President announced that the SANDF would assist the police in enforcing lockdown rules, but that they should perform their duty with empathy and in a spirit of service to the country. South Africans were supposed to feel secure. 
Cynics raise questions
Yet, cynics raised questions about the fitness of the untrained SANDF to perform these duties and of the SAPS which, according to the latest crime statistics, all but lost ‘the war on crime’. Cynics raised questions about the ability of the public healthcare sector to use the time bought by the lockdown to ready itself for the inevitable rise in the numbers of infected South Africans who would need very specific healthcare, and to protect its healthcare workers. Cynics questioned the lack of data with which decisions are made and the reluctance to start planning for getting out of lockdown for the sake of the economy. These questions were met with accusations of being unpatriotic, tone-deaf, and choosing to save the economy over dying South Africans.
These questions became prevalent after the announcement of the phased approach on 23 April. Commentators, journalists, politicians across party lines, as well as ordinary citizens once again began to realise the validity of being cynical. There are many reports of brutality by the SANDF and SAPS, so there are understandably fears regarding the deployment of thousands more soldiers. The phased approach will rely heavily on local government machinery; so, how will the accountability for financial and performance management work when it continues to worsen in most municipalities.
It is good to be cynical; cynics are believed to be more vigilant, to question, and to expect answers. The problem is that cynics often do not get the answers and then stop participating. This is something we as South Africans cannot afford at a time when our freedoms are encroached upon. We need to be more vigilant than ever. Listen to the cynics. See if their questions are answered (not spun), because the expectations from government in the coming months are going to be immense and South Africans must make these expectations clear.
Opportunity 
Provinces and local governments must carefully discern what these measures mean for each region and communicate this clearly. The latter has been sorely lacking up to now where most provinces and local governments are concerned. Oversight on all levels of government should not only be allowed but welcomed. There is time and opportunity to address all these concerns to prevent chaos and confusion. Public trust and participation are essential for this process to succeed. All the good governance principles such as transparency, accountability, responsiveness, etc., are required to ensure the success of the implementation of any government process, just as it has always been. This is an opportunity to use an enormous crisis to put these principles at the center for a change. One lives in hope...

Dr Ina Gouws is Senior Lecturer: Programme: Governance and Political Transformation in the Faculty of the Humanities.

News Archive

A position statement by the School of Medicine, UFS, regarding the crisis in health care in the Free State
2009-05-27

The executive management of the School of Medicine (SOM) at the University of the Free State (UFS) and its senior members wish to express their grave concern at the way the financial crisis in the Free State has negatively impacted on the provision of health care to the population. The unavailability of goods and services at every level of care has become so severely compromised that the staff of the SOM can no longer remain silent on this issue. By remaining silent it may be construed that we are either indifferent to, or even accepting the situation. Neither is true. The SOM can in no way condone, sanction or accept the current situation of health care in the Free State.

Other concerns expressed by the SOM include:

  • Medical services have been severely compromised due to the disintegrating primary health care system in the FS. This has resulted in patients who were in need of more advanced levels of medical care not being referred appropriately or timeously to level two hospitals and from there for tertiary care. Inpatient as well as outpatient numbers are steadily declining and the tendency now is to fill fewer beds with critically ill or terminally ill patients. It is also becoming increasingly difficult to find suitable patients for training and examination purposes.
     
  • It becomes more difficult to attract and retain experienced and suitably qualified medical specialists interested in an academic career, due to the inability to provide prospective career opportunities. This is particularly the case in the surgical disciplines.
     
  • It is also becoming more difficult to attract and appoint highly qualified registrars (future specialists) since the reputation of this SOM has been compromised by the negative publicity created by the financial difficulties of the FSDoH. Registrars form the backbone of the clinical work force in all teaching hospitals. If vacant posts cannot be filled in time service provision, as well as undergraduate teaching are severely jeopardised.
     
  • As a direct consequence of the rationing of health care, fewer surgical procedures are being performed. The point may soon be reached where registrars in the surgical disciplines may not get sufficient hands-on experience to allow them to qualify within the required time frame.
     
  • Non-payment of accounts to service providers and suppliers including the National Health Laboratory Services (NHLS), maintenance contracts and industry will severely compromises health care and future loyalty, goodwill and provision of critical services.
     
  • The dwindling number of qualified and experienced nurses in the public (and private) health care sector is an ongoing unresolved issue. Despite the fact that primary health care is mainly nurse-driven, nursing colleges were closed during the previous decade. These colleges must now be re-commissioned at high cost adding to the financial burden.
     
  • The morale of health care workers at all levels of health care has reached an all-time low
     
  • It is becoming increasingly difficult to conduct meaningful research in all disciplines due to staff shortages and lack of funding.

See attachment for the full statement on by the School of Medicine, regarding the crisis in health care in the Free State.

Media Release
Issued by: Mangaliso Radebe
Assistant Director: Media Liaison
Tel: 051 401 2828
Cell: 078 460 3320
E-mail: radebemt.stg@ufs.ac.za
26 May 2009
 

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