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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

Fighting the tuberculosis battle as a collective
2015-09-28



The team hard at work making South Africa a
healthier place

Tuberculosis (TB) is second only to HIV/AIDS as the greatest killer worldwide due to a single infectious agent. More than 95% of TB deaths occur in low- and middle-income countries. Despite being more prevalent among men than women, TB remains one of the top five causes of death amongst women between the ages of 15 and 44 years. While everyone is at risk for contracting TB, those most at risk include children under the age of five and the elderly. In addition, research indicates that individuals with compromised immune systems, household contacts with pulmonary TB patients, and healthcare workers are also at increased risk for contracting TB.

According to the Deputy Director of the Centre for Health Systems Research and Development (CHSR&D) at the UFS, Dr Michelle Engelbrecht, research has found that healthcare workers may be three times more likely to be infected by TB than the general population.

The unsettling fact

“Research done in health facilities in South Africa has found that nurses do not often participate in basic prevention acts, such as opening windows and wearing respirators when attending to infectious TB patients,” she explained. 

In response to this concern, CHSR&D, which operates within the Faculty of Humanities at the the University of the Free State (UFS) Bloemfontein Campus has developed a research project to investigate TB prevention and infection control in primary healthcare facilities and households in Mangaung Metropolitan.

Action to counter the statistics

A team of four researchers and eight field workers from CHSR&D are in the process of gathering baseline data from the 41 primary healthcare facilities in Mangaung. The baseline comprises a facility assessment conducted with the TB nurse, and observations at each of the facilities. Individual interviews are also conducted with community caregivers, as well as TB and general patients. Self-administered questionnaires on knowledge, attitudes, and practices about TB infection control are completed by all nurses and facility-based community caregivers.

Healthcare workers are the main focus of this research, given their increased risk of acquiring TB in healthcare settings. At clinics, interventions will be developed to improve infection control practices by both healthcare workers and patients. TB patients’ households are also visited to screen household contacts for TB. Those found to have symptoms suggesting TB infection are referred to the clinics for further assessment and treatment.

The findings of this study will serve to inform the development of an intervention to address TB prevention and infection control in primary healthcare facilities. Further funding will be sought to implement and evaluate the intervention.

Curbing future infections and subsequent deaths as a result of TB is the priority for the UFS. The cooperation and collaboration of the community, government, and sponsors will ensure that this project is a success, hence prolonging life expectancy.


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