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28 October 2021 | Story Prof Sethulego Matebesi | Photo Sonia Small (Kaleidoscope Studios)
Dr Sethulego Matebesi
Prof Sethulego Matebesi is an Associate Professor and Head of the Department of Sociology at the University of the Free State (UFS)

Opinion article by Prof Sethulego Matebesi, Associate Professor and Head of Department of Sociology, University of the Free State.
When a catastrophic accident cuts the first manned mission to Jupiter’s moons short in the Astronaut: The Last Push a 2012 American science fiction film – Michael Forrest, the sole remaining astronaut, must endure the three-year return trip to Earth alone. Similarly, how will the next five-year journey of local governance in South Africa manifest itself? Again, I reckon the responses from citizens will vary widely: from widespread cynicism to hope for a better future and from distrust of a dysfunctional system to the belief that service delivery will improve.

In an all-too-familiar scenario, political party campaigns have been littered with promises of how they best represent and advance voters’ interests. In doing so, two helpful facts about these campaigns emerge. The first is that the ANC, DA, EFF, and FF+ have realised that local contexts differ significantly and have framed their messages accordingly. A cursory glance at the broadcastings of these customised campaigns reveals that they aim to provide a safe psychological outlet for community-level concerns. The second is that, in general, the election messaging and adverts of the ANC ranged from apologies to bold statements about who wields power to change the face of local governance. Opposition parties focused on improving the local government system notoriously known for the disregard of citizens’ needs and providing an active voice for the voiceless.

And guess what?

Political parties and candidates may mobilise constituencies as much as they can. However, the next five years of local governance require a significant departure from its status of dysfunctionality to a competent, legitimate political institution that produces satisfactory political outcomes. This legislative and moral mandate depends entirely on local participation in elections.

The three dimensions of increasing voter participation

Better and more meaningful political participation in elections remains a concern in South Africa. In a report for the Ford Foundation, Hahrie Han, a political science professor at the University of California, proposes a framework that details increasing participation and making it more meaningful.

Firstly, people must be able to participate. Declaring election day as a public holiday, President Cyril Ramaphosa removed an important barrier to participation. While some may believe that election day will be just another public holiday, for others – particularly those who are working – there is no need to weigh up whether to take leave for a cause that will not significantly change their lives. Furthermore, the Independent Electoral Commission (IEC) has demonstrated a sense of moral urgency by drawing unprecedented public attention to their voting processes and procedures to protect voters and election officials from spreading the virus at the polling stations.

Secondly, people must want to participate. Here, political parties and election candidates should not take voting as a taken-for-granted part of the repertoire of residents’ political activities. Election campaigns – both online (internet) and offline (door-to-door engagements, posters, and billboards) remain a powerful medium to improve visibility and deliver messages to solicit interest from citizens. But once these campaigns conclude, still, it remains an individual’s choice to want to participate in the elections. While it is difficult to assess the level of voter engagement with the election campaigns under COVID-19 restrictions, the general political climate in South Africa seems to be conducive for free and fair elections. Yet political assassinations continue to cast a dark shadow over the local government elections. This cruel feature of political life in the country serves as an ultimate intimidation tactic. It denies candidates the right to stand for election and citizens to choose their preferred public representatives.

Thirdly, Hahn argues that for people to want to participate in the political process, their participation must matter. Therefore, aside from building a sense of agency and encouraging greater participation in elections, people still need to be convinced that their vote counts and influences decisions at the local level, where voters have the chance to participate directly in the election of local councillors.

Disrupting the balance of power in local councils 

Regardless of the challenges it faces, the ANC remains in pole position to retain most of the local councils it leads. I believe there is much to be discontented about, but opposition parties – including civic forums – have yet to build the power to break the stranglehold the ANC has on elections – and that is no small task.

Interestingly, in contrast to the DA, the ANC has paradoxically avoided announcing their mayoral candidates in direct response to prevent the electoral backlash it received in the metros during the 2016 local government elections. Yet, except for a few local councils in several provinces, the metros are precisely where the most significant disruption to the balance of power will occur. 

Whether political parties will deal with the standoffs of coalition politics in hung councils, while broaching complex issues, remains a concern for South Africans. But elections remain an excellent opportunity for citizens to participate and influence local political decision-making.

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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