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15 February 2021 | Story Prof Sethulego Matebesi | Photo Sonia Small
Dr Sethulego Matebesi
Prof Sethulego Matebesi is a senior lecturer and Academic Head of the Department of Sociology at the University of the Free State.

 

Opinion article by Prof Sethulego Matebesi, Senior Lecturer and Academic Head of the Department of Sociology in the Faculty of The Humanities, University of the Free State. 

In Langston Hughes’ poem, Harlem, the opening line poses a simple yet profound question: ‘What happens to a dream deferred?’ Hughes then arrives at a provocative conclusion: ‘Maybe it just sags like a heavy load. Or does it explode?’

In sharp contrast, President Cyril Ramaphosa’s 2021 State of the Nation address expectedly began by sharing a story of hope, resilience, and inspiration. In a slight departure from his usual presentation style, powerful rhetorical and inspiring themes were a notable feature of the President’s address. By highlighting South Africa’s COVID-19 vaccine rollout programme, boosting the unemployment rate, economic recovery, and fighting corruption as the government’s key priorities, the President wove together the challenges and opportunities we face as a nation.

Pitfalls of the mass vaccination drive

Thus far, the South African government has led a commendable intervention strategy against the coronavirus. While there seems to be a concrete vision of how to implement the mass vaccination drive, the realisation is there is overwhelming evidence of how various challenges have compromised immunisation programmes in the country. Adopting the current Expanded Programme on Immunisation (EPI) strategies to champion the COVID-19 mass vaccination drive will be insufficient in the context of porous borders, overwhelmed primary healthcare workers, and intense and significant epidemiological changes of the virus. The last challenge is not only akin to SA. Therefore, it is imperative that a better understanding of population mobility and more targeted and evidence-informed strategies will be crucial in mounting a sufficient mass vaccination drive.

Unemployment – a mixed bag of fortunes 

Long before COVID-19 ravaged the South African labour market, unemployment has been one of the country’s key challenges. In a country where half of the youth are unemployed, it was expected that SONA 2021 would provide a glimmer hope to subvert the poor socio-economic outcomes of unemployment. But the dream for many unemployed South Africans remains out of reach as short-term initiatives such as the extension of the Special COVID-19 Grant of R350 and the Presidential Employment Stimulus will not be able to cushion the ravages of long-term unemployment many South Africans have to endure. Despite the delays and teething implementation challenges of these employment relief packages, they will again face a breaking point when these interventions end.

The COVID-19 pandemic has undoubtedly led to an unprecedented number of job losses. This situation will continue due to deindustrialisation, depressing investment and the complacency of South African institutions. For example, the President mentioned several relief measures, including the Public Employment Programme, which created 3.2 million work opportunities. However, there remain serious doubts about planning around youth employment.

The President stated that the government reached 1,000 businesses by International Youth Day in August 2020, is a far cry from the 15,000 start-ups planned to be supported by 2020. Another complicating factor is that institutions like the National Youth Development Agency (NYDA), which has to play a leading role in assisting young citizens to become successful entrepreneurs, is highly politicised and embedded in the intra-political battles of the ruling party. The fact that there is still no board for the NYDA is indicative of the challenges of fighting youth unemployment. Effective managerial accountability and control of financial resources will go a long way in assisting agencies such as the NYDA in meeting their mandates.

Economic recovery and corruption

The President’s speech highlighted a myriad of plans to restructure, rebuild and revive the South African economy. Comparatively, the President's fifth SONA had more detail about milestones reached and practical strategies to implement plans. Expectedly, he also lamented the impact of state capture and the COVID-19 pandemic.

South Africans are now looking to finance minister, Tito Mboweni’s upcoming national Budget Review for details on how the government will fund the President's priorities. However, attempts to grow an ailing economy are impeded by the continuing energy supply crisis, the lack of scope to utilise digital technologies to shape economic opportunities, and rampant corruption.

The measures against corruption mentioned in the State of the Nation are welcomed. The same cannot be said about the political commitment to deal with the challenge. But what difference will the launch of a National Anti-Corruption Advisory Council make if the government fails to act decisively on the Auditor-General’s reports which highlight an average of R50billion in irregular expenditure annually? Pronouncements by the President about fighting corruption have become a norm. There are pockets of success in this regard. Yet the scourge of corruption and greed in government institutions continues unabatedly.

Global experience has shown that robust, transparent and accountable public institutions can be catalytic in securing and sustaining good governance. Without good governance, our youth will continue to stand on street corners looking for jobs, many will continue to go to bed on empty stomachs, our lights will remain off, and we will continue to be imprisoned in our homes due to the high crime rate in the country. 
Only time will tell what will happen to dreams deferred yet again.

News Archive

Heart diseases a time bomb in Africa, says UFS expert
2010-05-17

 Prof. Francis Smit

There are a lot of cardiac problems in Africa. Sub-Saharan Africa is home to the largest population of rheumatic heart disease patients in the world and therefore hosts the largest rheumatic heart valve population in the world. They are more than one million, compared to 33 000 in the whole of the industrialised world, says Prof. Francis Smit, Head of the Department of Cardiothoracic Surgery at the Faculty of Health Sciences at the University of the Free State (UFS).

He delivered an inaugural lecture on the topic Cardiothoracic Surgery: Complex simplicity, or simple complexity?

“We are also sitting on a time bomb of ischemic heart disease with the WHO (World Health Organisation) estimating that CAD (coronary artery disease) will become the number-one killer in our region by 2020. HIV/Aids is expected to go down to number 7.”

Very little is done about it. There is neither a clear nor coordinated programme to address this expected epidemic and CAD is regarded as an expensive disease, confined to Caucasians in the industrialised world. “We are ignoring alarming statistics about incidences of adult obesity, diabetes and endemic hypertension in our black population and a rising incidence of coronary artery interventions and incidents in our indigenous population,” Prof. Smit says.

Outside South Africa – with 44 units – very few units (about seven) perform low volumes of basic cardiac surgery. The South African units at all academic institutions are under severe threat and about 70% of cardiac procedures are performed in the private sector.

He says the main challenge in Africa has become sustainability, which needs to be addressed through education. Cardiothoracic surgery must become part of everyday surgery in Africa through alternative education programmes. That will make this specialty relevant at all levels of healthcare and it must be involved in resource allocation to medicine in general and cardiothoracic surgery specifically.

The African surgeon should make the maximum impact at the lowest possible cost to as many people in a society as possible. “Our training in fields like intensive care and insight into pulmonology, gastroenterology and cardiology give us the possibility of expanding our roles in African medicine. We must also remember that we are trained physicians as well.

“Should people die or suffer tremendously while we can train a group of surgical specialists or retraining general surgeons to expand our impact on cardiothoracic disease in Africa using available technology maybe more creatively? We have made great progress in establishing an African School for Cardiothoracic Surgery.”

Prof. Smit also highlighted the role of the annual Hannes Meyer National Registrar Symposium that culminated in having an eight-strong international panel sponsored by the ICC of EACTS to present a scientific course as well as advanced surgical techniques in conjunction with the Hannes Meyer Symposium in 2010.

Prof. Smit says South Africa is fast becoming the driving force in cardiothoracic surgery in Africa. South Africa is the only country that has the knowledge, technology and skills base to act as the springboard for the development of cardiothoracic surgery in Africa.

South Africa, however, is experiencing its own problems. Mortality has doubled in the years from 1997 to 2005 and half the population in the Free State dies between 40 to 44 years of age.

“If we do not need health professionals to determine the quality and quantity of service delivery to the population and do not want to involve them in this process, we can get rid of them, but then the political leaders making that decision must accept responsibility for the clinical outcomes and life expectancies of their fellow citizens.

“We surely cannot expect to impose the same medical legal principles on professionals working in unsafe hospitals and who have complained and made authorities aware of these conditions than upon those working in functional institutions. Either fixes the institutions or indemnifies medical personnel working in these conditions and defends the decision publicly.

“Why do I have to choose the three out of four patients that cannot have a lifesaving operation and will have to die on their own while the system pretends to deliver treatment to all?”

Prof. Smit says developing a service package with guidelines in the public domain will go a long way towards addressing this issue. It is also about time that we have to admit that things are simply not the same. Standards are deteriorating and training outcomes are or will be affected.

The people who make decisions that affect healthcare service delivery and outcomes, the quality of training platforms and research, in a word, the future of South African medicine, firstly need rules and boundaries. He also suggested that maybe the government should develop health policy in the public domain and then outsource healthcare delivery to people who can actually deliver including thousands of experts employed but ignored by the State at present.

“It is time that we all have to accept our responsibilities at all levels… and act decisively on matters that will determine the quality and quantity of medical care for this and future generations in South Africa and Africa. Time is running out,” Prof. Smit says.
 

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