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22 December 2023 | Story Dr Harlan Cloete | Photo Supplied
Dr Harlan Cloete
Dr Harlan Cloete is a research fellow in the Department of Public Administration and Management at the University of the Free State.


Opinion article by Dr Harlan Cloete, Department of Public Administration and Management, University of the Free State (UFS)


This week my Great Governance ZA podcast reached the 100-episode milestone. About a year ago I interviewed Prof Jaap de Visser on the platform and he argued that coalition governments are a natural consequence of our South African electoral system and that we must get used to this reality. On the 5 December we marked the passing of Nelson Mandela who led the first coalition government in South Africa, called the government of national unity. That coalition did not last beyond two years with the National Party walking out in 1996 because the ANC would not agree to extend the government of national unity beyond 1999, as well as a failure to reach consensus on key economic choices and policies. And so since 1996 the ANC has the sole mandate to ensure economic justice.

Today there is no greater failure than the failure of our economic policies. The fact the World Bank declared South Africa the most unequal country in the world is a direct consequence of our economic policy choices over a period of 30 years. We are faced with deep-rooted structural inequality, persistent generational poverty and rising youth unemployment. These problems will persist due to deteriorating state capacity and inappropriate policy management. How long will state indifference last? No one knows. The National Development Plan (NDP) review concludes that instead of a capable state, we have an increasingly corrupt state. And let me remind you that this corruption did not start in 1994, it is so deeply entrenched in our DNA – both the private and public sectors. This country was built on this political economic collusion resulting in centuries of economic and political injustice.

Fought for freedom and all we got was democracy

The NDP states that instead of a seamless planning system, we have a disjointed planning system that is poorly implemented and misaligned to the strategic goals of the NDP. Instead of a more inclusive and equitable economy, we have economic policies that do not seem to be achieving the transformation that is required. Social cohesion has fallen off the government priority list and is articulated superficially (Stronger Together – four rugby world cups and more divided than ever). South Africans experience some of the highest levels of violent interpersonal crime globally, especially violence against women.

And so we continue to be brilliant at identifying what is wrong but weak in implementing what must be done. I conclude that the constitution is not working, as summed up by a colleague: we fought for freedom and all we got was democracy. And so there is this deep sense of cynicism with our current politicians and the political system that continues to condemn people to misery and making them slaves to new forms of slavery, alcohol abuse being but one. South Africa has some of the highest rates of youth binge-drinking. The reality is that this democracy is working for the elites not the poor. The statistics show that we have about 62 million people, of which 45 million are eligible to vote, with close to 27 million people on the voters’ roll. In the 2019 election only 19 million people voted (42%) and in our COVID election in 2021 only 12 million voted (27%).

The reality is that we have more than 100 registered parties and more parties joining the ballot paper, the latest is the Activist and Citizens Forum calling for Dr Allan Boesak to lead. This leads me to conclude that people either form political parties because they see politics as entry into the middle class (given our high unemployment rate) and or they are genuinely disillusioned with the status quo and feel this to be the only way to express their dissatisfaction.

But there is opportunity in the crises. We now know what good leadership looks like, it is not what people say, it’s what they do. So what does a desired future look like? The NDP concludes that leadership and active citizenry will get us out of this deep hole. The reality is that the bar for political leadership is so low. Ours is a system of representative and participatory democracy. There is a total disconnect between the politicians and the people – social distance. The goodwill of the people is simply not matched by administrative and political will. That government is not prepared to meet people halfway, instead the system is designed to make you dependent (grants) in a disempowerment model. South African must decide. Are we active or passive citizens? In the broad sense (business, academia and civil society formations). Active citizens are involved, helping to shape society as expressed in a grassroots governance course spearheaded by colleague Ina Gouws at the University of the Free State (UFS). This requires hard work and deep commitment to build institutions. This is not elitist. In this, new knowledge and models are developed that serve to liberate people. Active citizenship irritates and keeps producing evidence demanding excellence and redistribution of wealth.

Citizen Coalition

If we think coalition government is the answer, we are making a big mistake. Such a government maybe even be more complex given the different egos demanding to be fed.  Rather a Citizen Coalition (social solidarity) is needed, where citizens lead and government follows. Unless we make that transition in our heads, we will forever be at the mercy of politicians trapped in a system that rewards only them. We cannot talk of a coalition government if we do not talk about citizen coalition – where we put your purpose together. Affluent well-resourced schools will continue to flourish unless we collaborate and share wealth. Such a citizen coalition is built on five principles viz namely, leadership behaviours that are based not on rent-seeking, economic inclusion, equal access to health care (dignity), equal access to education (a means to an end) and accountability systems.

The October 2022 report from Good Governance Africa suggests that excellence in municipal performance to a lesser extent is the consequence of which political party is in charge and more linked with governance, population, and provincial dynamics. However, what the study also showed is when you have ethical and competent leadership steering the ship to ensure that municipalities are properly governed in terms of Administration, Planning and Monitoring, and Service Delivery then there is a greater chance of success.

In October I was invited by the municipal council of the Theewaterskloof municipality to facilitate a three-day strategic conversation using my Governance 5iQ model as point of departure. This model asks five questions. Why we do what we do (vision)? How is it being done (mission)? How will we know at any given time we are on track (M&E)? If we are not on track, what are we doing about it (consequence management)? And finally, how we lead and learn (knowledge management). I believe the Governance 5iQ could be applied in conversation around the viability of a Citizen Coaltion.

The desired state is inclusive coalition governance not coalition government that is achieved through building coalition governance competence on all levels of society. The cornerstone of this coalition governance is a partnership between civil society, the private sector, government, and academia, as concluded in the NDP review. Where we co-create a desired future. And this must be youth led. It can be done, we owe it to the youth who rightfully question the motives of those who are trying to fix problems they themselves created over the past three decades. This is hard work. But there is no better time than the present.

Dr Harlan Cloete is a research fellow at the UFS. His main research interest is exploring evidence-based HRD governance systems in the public sector, with a keen interest in local governance. He is the founder of the Great Governance ZA Podcast https://anchor.fm/harlan-ca-cloete

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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