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21 June 2022 | Story Prof Pearl Sithole | Photo Sonia Small
Prof Pearl Sithole
Prof Pearl Sithole is Vice-Principal: Academic and Research at the Qwaqwa Campus, University of the Free State

Opinion article by Prof Pearl Sithole, Vice-Principal: Academic and Research, Qwaqwa Campus, University of the Free State.
Public service is the heart of the strategic and operational compass of any country. Whereas politics is in the space of driving the national vision, socio-economic positioning of a country and consolidating the symbolic essence of a nation; public service is the heartbeat of monitoring strategy against present coalface realities.  Political leadership can successfully focus on visioning if its relationship with public administration is healthy. This means there must be professionals who can, on the one hand, advise on strategic scenarios to achieve a political vision, and on the other, fine-tune professionalism for the everyday service experience of the citizen as they tap into government products to assist living and livelihoods. A healthy relationship is one that has sufficient thresholds of expertise, operational agility, ethics and visioning for both political office-bearers and public servants. It is that mutual respect for vision and professional lines that influence each other that makes or breaks the functionality of public administration in any country. It has to be a tango of political and professional strategising that happens best when the country has a fair degree of patriotism amongst its important stakeholders, including business.

Sadly, in recent times there is very little good news regarding the performance of the public service in South Africa. Of course, some within a largely failing system are trying very hard to do their best. Yet public service and public administration in South Africa is deteriorating from a culture, structure and agency perspective. The issues are as follows:

• Inability to balance routine maintenance, new projects and growth for real places: ‘Service’ and ‘delivery’ are not seen as two missions that can benefit from quality execution. Since their conflation into ‘service delivery’ the phrase is more of a political statement exemplifying point scoring. Basically, whether it is at municipal level or provincial level, routine maintenance of roads, robots, servicing drainage systems is a difficult task for the South African public service. Tasks that were once done directly by government departments for reasons to do with regular service routine are now thrown into the outsourcing culture.

• Medium- to long-term planning is good on paper rather than afforded champions and structures to see these through: In South Africa we do not need to be reminded about the aging infrastructure in most municipalities – it is a reality seen in the quality of tap water in some municipalities. There should have been professionals doing projections for growing capacity demands on energy and water. Clearly this was not to be – despite the existence of technical units within local and provincial government, and huge national departments and Commissions existing to support these specialisations. South Africa is seen aspiring and punting 4IR aligned ways of doing things, including acquiring health equipment that cannot be sustained locally. Even innovation and advancement is not planned from the point of view of sustainability and carefully funding national capability.

• Professionalism is not receiving continuous attention within institutions and in monitoring and evaluation approaches: South Africa is wrestling with a huge human resource bill with many sitting in positions where they lament capacity. Studies are yet to be done to ascertain the lag between capacity and capability – given the changing world of work and the need for dynamic systems to respond to issues. Many academic institutions share amazing potential solutions to everyday problems – solutions for which public administration is not ready because of its unchanging formats. In fact, academic institutions, which are sometimes blamed for not preparing students for the (changing) world of work, have reason to suspect that public administration wants to tame the critical innovative thinkers they produce into imbibing the archaic formatted processes that are not changing with the times.

• Data-driven, evidence-based approaches have purged all qualitative, context-driven service: Communities are suffering from an impersonality of service and systems that refuse to offer human service. Tele-systems with voice prompts and generic emails are supposedly ‘servicing’ people with nuanced problems, and there is no way to follow-up on issues. Things may be reported to human professionals in certain locations but they ultimately find themselves as data in impersonal systems. Recent talk of special relief social grant applicants accessing the internet to supply or change their details, as well as connect with banks – is an amazing case of middle-class consciousness imposed on poor people, most of whom are in rural areas and informal settlements. Clearly South Africa has blunted its capability to respond to real people in real time through its devaluing of qualitative experience. ‘Service’ has removed ‘the person’ on either end of the need-and-service spectrum. This exacerbates alienation and bitterness towards public service establishments.
 
• Cycles of planning away poverty are an end in themselves: No country speaks of planning and reporting more than South Africa. The only problem is that the physical impact does not match the planning and reporting. Instead it does seem that the plans have certain descriptors that have lost ‘feeling’ and ‘lost entitlement for change’. One of them is reference to ‘the poor’. No descriptor legitimises planning, conferencing and reporting, than the concept of ‘the poor’; but the static nature of numbers and criteria forcing people to remain poor in order to access help is an inbuilt conundrum of South African planning. 

A question has to be asked as to whether a typical South African public service manager would be scared for their job if they woke up to ‘no poor people’. The point is: If public service mainly exists to ‘solve poverty’ then developing countries actually do not want to be developed. I am making this point because it seems there is no aspiration for ‘quality of service’, ‘solving poverty’, ‘creating a service blend suitable for circumstance’, or ‘growing development precincts in real spaces’ in South Africa. public servants are working on reducing people to data and generating overlays of faceless needs.  

This speaks to the ethos, ethics and culture of public service locally and the public administration system internationally. Let me be blunt about this point: there has never been freedom from colonial formats of public administration because it is in the interest of certain global bodies to find docile public service in African countries. Their ‘poor’ is the less dynamic systems in developing countries. This is what I call the qualitative colonial dividend.

In conclusion 

Of course, no one wants to over-emphasise bad news but a deterioration of public service is one of the notable trends of post-independence in many African countries. Why is it that a professional layer of government is not able to salvage its country, and we all blame the politicians? The reasons are both structural and related to devaluing professionalism. An over-arching culture of formats importation that structure the relationship between the globe and former colonies speaks to structural colonial dividends to be gained from dysfunctional public administration regimes. The colonial dividends strategy seems to be: ‘Beyond making countries beg for foreign investment, tame their tools and call that “a request for a permitting environment” – then excessively format the way they work’.   

Let me end by specifying the real sore points that must to be sorted if we are to resuscitate the South African public service:
We need to sort human resource systems and practices: Currently HR recruitment systems are not versatile and they discourage agility in their recruitment criteria. There are no mechanisms to assess the capable “butterflies” that have been bravely hopping between related sectors. The people who hold the answer to the responsive leadership and discretion are often punished for not being stagnant.

A need to resolve the capacity vs capability debacle: Responsive capability is curtailed by valorising already existing ways of doing things in spite of a technology mix that may be afforded, a possibility of designing new cross-sector policies that allow different specialists to work together, of retraining needed to respond to new situations.

Speaking truth to powers of vigilance – that should be supporting core business: No matter how versatile public service can be in response to developmentalism, if the disciplines that see their role as vigilance over resources are only operating from the stance of distrust, there shall be no responsiveness. These disciplines are Planning, Monitoring and Evaluation, as well as Finance and Auditing. In South Africa they are famous for stating ‘why things cannot be done’ rather than ‘how they can be done’. If this will change, they will need to see sector partners as equal partners with essential expertise for advancing the development mission. These ‘disciplines of vigilance’ may even create accountable discretionary points closer to the coalface instead of only recognising a priori planning-based expenditure even for unforeseen situations.

Finally, someone needs to whisper to all future presidents, especially for their State of the Nation Addresses (SONA), that: “it is OK to prioritise and pinpoint focal areas when it comes to designing an annual strategic direction”. SONAs actually endorse silos. In South Africa even cameras will point to a specific minister as the President jumps from one sector to the next. Being issue-based and resolving major developmental conundrums that have a spiralling effect on other issues is the way to go. SONAs are short, but they can garner determination towards a well-considered mission.

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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