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15 February 2022 | Story Prof Sethulego Matebesi
Prof Sethulego Matebesi
Prof Sethulego Matebesi, University of the Free State

Long before delivering his fifth State of the Nation Address (Sona), concerns reverberated in the political and social corridors surrounding President Cyril Ramaphosa, urging him to make conclusive statements, to have the heads roll of those implicated in corruption, and to report on achievements and challenges. However, the somewhat overwhelming dismissive responses from prominent opposition party leaders may seem as if they are not eager to engage with the Sona constructively. Thus, it seems that no matter how well the Sona is delivered, there will always be those who dismiss it as a trivialisation of South Africa’s challenges.

There were times during one or two of the ‘family meetings’ – live broadcasts by the President, addressing the nation on the status of the COVID-19 pandemic and the regulations to be amended – that it was vividly evident that Ramaphosa was taking strain. However, all this was gone when President Ramaphosa delivered the Sona like a true statesman, without any visible signs of the ambush he was facing from within and outside his own political party. In fact, the need to be bold and resolute about the government’s stability has never been stronger after recent attacks on several national key points across the country.

Assumed power of reports from commissions, advisory panels, and advisory councils

In a recent Reading Group Session of the Department of Sociology, we discussed the assumed power of documents when conducting research. The emphasis was on the need to avoid an over-zealous reduction of a research question to documentary evidence without considering the document’s terms (or context). Similarly, it is interesting to note that since 2018, President Ramaphosa has established 24 advisory panels, advisory councils, task committees, and commissions. While it may seem rather obvious that some of these panels have been designated by statute for a specific purpose, the assumed powers of the reports produced are sometimes the most difficult to unravel.

One such instance is the report of the Zondo Commission of Inquiry into State Capture, which was viewed as a magic wand that would root out corruption and strengthen the rule of law. In the face of the complex set of interlocking challenges that are hampering structural growth and change in South Africa, reports from committees may provide an in-depth examination of issues. However, there are at least two problems with policy makers who invariably think that these reports, including national addresses such as Sona, are solutions to the country’s myriad challenges.

First, a recent publication of Transparency International highlights how some governments are trivialising the results of its Corruption Perceptions Index (CPI). The trivialisation mainly happens when leaders who have come into office with a strong anti-corruption narrative, fail to make inroads against this scourge. For example, in South Africa, pronouncements on corruption – one of the leading causes of the state’s failure to deliver on promises – have been so subtle that those involved in corrupt practices may not even notice the seriousness of their acts.

The other problem is the reluctance to change non-performing accounting systems that are susceptible to abuse. South Africa has been trying to fix the puzzle of corruption long before the arrival of the Zondo Commission. Therefore, acknowledging that public institutions and state-owned enterprises (SOEs) have been infiltrated by a criminal network intent on looting public money is merely a starting point but not a satisfactory explanation in its own right. Moreover, it does not account for the government’s glaring failure to act upon the Auditor-General’s annual findings on irregular and unaccounted expenditure. It would have been more desirable for the government to insist on better financial accountability than its over-reliance on commissions or advisory panels.

As the nation waits with bated breath to see how corruption is tackled ‘once and for all’, as the President announced, a further qualification needs to be made regarding the proposed disposal of the government’s non-strategic SOEs. Estimates of global trends in privatisation indicate that privatisation activities are on the rise. In South Africa, there is a great deal of evidence that a handful of politically connected individuals often benefit from the privatisation of government assets. This raises important questions that are beyond the scope of this contribution, for example, how SOEs will be further weakened to hasten the process of privatisation.

Victorious we can emerge, but only if …

President Ramaphosa made a bold statement through his promise and commitment to revitalise the country’s weak economy, deal with Eskom’s unreliable electrical supply, and bring about changes to security agencies, among others. The extent, urgency, and sincerity with which the government will implement these and many other commitments, will determine whether we will ‘emerge victorious’, as Ramaphosa announced.

Mr President, we know the road ahead will not be easy. But in many ways, there has been an improvement. One possible solution to continue this trajectory of accountability and improved service delivery is to take full advantage of the benefits of the digital age. A digitisation drive underscored by a consequence management approach may assist in implementing the Sona promises and commitments in a more efficient, flexible, and sustainable manner. In this way, South Africa will begin to ‘walk the talk’ against poverty, unemployment, and inequality.


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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