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The value of cynicism – South Africa’s reaction to the pandemic and our government

06 May 2020 | Story Dr Ina Gouws | Photo Supplied

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

Higher than expected prevalence of dementia in South African urban black population

2010-09-22

Prof. Malan Heyns and Mr Rikus van der Poel

Pilot research done by University of the Free State (UFS) indicates that the prevalence of dementia, of which Alzheimer’s disease is only one of the causes, is considerably higher than initially estimated. Clinical tests are now underway to confirm these preliminary findings.

To date it has been incorrectly assumed that dementia is less prevalent among urban black communities. This assumption is strongly disputed by the findings of the current study, which indicates a preliminary prevalence rate of approximately 6% for adults aged 65 years and older in this population group. Previous estimates for Southern Africa have been set at around 2,1%.

The research by the Unit for Professional Training and Services in the Behavioural Sciences (UNIBS) at the UFS and Alzheimer’s South Africa is part of the International 10/66 Dementia Research Group’s (10/66 DRG) initiative to establish the prevalence of dementia worldwide.

Mr Rikus van der Poel, coordinator of the local study, and Prof. Malan Heyns, Principal Investigator, say worldwide 66% of people with dementia live in low and middle income countries. It is expected that it will rise to more than 70% by 2040, and the socio-economic impact of dementia will increase accordingly within this period. 21 September marks World Alzheimer’s Day, and this year the focus is on the global economic impact of dementia. Currently, the world wide cost of dementia exceeds 1% of the total global GDP. If the global cost associated with dementia care was a company, it would be larger than Exxon-Mobil or Wal-Mart.

The researchers also say that of great concern is the fact that South Africa’s public healthcare system is essentially geared toward addressing primary healthcare needs, such as HIV/Aids and tuberculosis. The adult prevalence rate of HIV was 18,1% in 2007. According to UNAIDS figures more than 5,7 million people in South Africa are living with HIV/Aids, with an estimated annual mortality of 300 000. In many instances the deceased are young parents, with the result that the burden of childcare falls back on the elderly, and in many cases elderly grandparents suffering from dementia are left without children to take care of them. “These are but a few reasons that highlight the need for advocacy and awareness regarding dementia and care giving in a growing and increasingly urbanized population,” they say.

Low and middle income countries often lack epidemiological data to provide representative estimates of the regional prevalence of dementia. In general, epidemiological studies are challenging and expensive, especially in multi-cultural environments where the application of research protocols relies heavily on accurate language translations and successfully negotiated community access. Despite these challenges, the local researchers are keen to support advocacy and have joined the international effort to establish the prevalence of dementia through the 10/66 DRG.

The 10/66 DRG is a collective of researchers carrying out population-based research into dementia, non-communicable diseases and ageing in low and middle income countries. 10/66 refers to the two-thirds (66%) of people with dementia living in low and middle income countries, and the 10% or less of population-based research that has been carried out in those regions.

Since its inception in 1998, the 10/66 DRG has conducted population based surveys in 14 catchment areas in ten low and middle income countries, with a specific focus on the prevalence and impact of dementia. South Africa is one of seven LAMICs (low and medium income countries) where new studies have been conducted recently, the others being Puerto Rico, Peru, Mexico, Argentina, China and India.

Mr Van der Poel says participating researchers endeavour to conduct cross-sectional, comprehensive, one-phase surveys of all residents aged 65 and older within a geographically defined area. All centres share the same core minimum dataset with cross-culturally validated assessments (dementia diagnosis and subtypes, mental disorders, physical health, anthropometry, demographics, extensive non-communicable risk factor questionnaires, disability/functioning, health service utilization and caregiver strain).

The local pilot study, funded by Alzheimer’s South Africa, was rolled out through an existing community partnership, the Mangaung University of the Free State Community Partnership Programme (MUCPP).

According to Mr Van der Poel and Prof. Heyns, valuable insights have been gained into the myriad factors at play in establishing an epidemiological research project. The local community has responded positively and the pilot phase in and of itself has managed to promote awareness of the condition. The study has also managed to identify traditional and culture-specific views of dementia and dementia care. In addition, existing community-based networks are being strengthened, since part of the protocol will include the training and development of family caregivers within the local community in Mangaung.

“Like most developing economies, the South African population will experience continued urbanization during the next two decades, along with increased life expectancy. Community-based and residential care facilities for dementia are few and far between and government spending will in all probability continue to address the high demands associated with primary healthcare needs. These are only some of the reasons why epidemiological and related research is an important tool for assisting lobbyists, advocates and policymakers in promoting better care for those affected by dementia.”

Media Release
Issued by: Mangaliso Radebe
Assistant Director: Media Liaison
Tel: 051 401 2828
Cell: 078 460 3320
E-mail: radebemt@ufs.ac.za
21 September 2010

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