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14 February 2023 | Story Prof Sethulego Matebesi | Photo Sonia Small
Prof 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 the Department of Sociology, University of the Free State.
A maxim says it is not enough to know that people have made mistakes; we need to understand why they made the mistakes if we hope to prevent them or others from making the same mistakes.

While South Africans are still trying to make sense of the many lofty promises made about measures to deal with the catastrophic energy crisis over the past four years, unsurprisingly, the restoration of energy security also dominated the 2023 State of the Nation Address (SONA).

Still, the reasons behind the failure of past intervention measures and progress with restructuring the state’s energy utility, Eskom, remain a mystery.

There is enough cause for concern over Eskom’s stance that an ageing fleet of coal-fired power stations that consistently break down is one of the reasons for load shedding. What happened to planning? No wonder the need to achieve quick success in resolving the energy crisis has placed a premium on maintaining citizens’ trust. As a result, the government proposed new initiatives to address the insecurity of the electricity supply by declaring a state of emergency to avert a complete blackout and appointing a new Minister of Electricity within the presidency to lead the government’s short-term energy crisis response. 

President Cyril Ramaphosa has already indicated that the criticism of the Minister of Electricity’s position is misguided. In other words, from the government’s perspective, the impact of its decisions does not matter. To South African citizens, however, it matters a great deal as they have borne the burden of load shedding and the rising cost of living. Above all, those who can cushion the blow of the energy crisis will want to see that the maximum value for public money is achieved.

The energy crisis has been the subject of fierce arguments over the past few years. So too, have deliberations on the government’s capability to deal with the crisis. And although the precise impact of the state of disaster, which began with immediate effect after its announcement in the SONA, cannot be determined at this stage, it is not premature to believe that the energy crisis will become a high-stake bidding game during the 2024 general elections. 

From the responses of the African National Congress (ANC) parliamentarians and alliance partners, one gets the sense that they sincerely wish there could have been a less dramatic option for the electricity minister, who has been touted to serve merely as a project manager.

Disastrous decisions are a recipe for catastrophic events

There has never been a time in South African history since 1994 that our presidents have not faced one scandal or another. After having temporarily thwarted the Phala Phala saga and emerging victorious as leader of the ANC at the 55th National Conference in December 2022, one would assume that President Ramaphosa would have assimilated the lessons from past events.

The post-SONA 2023 political landscape points to a challenging year for Ramaphosa. It is a truism that an organisation’s culture is determined by its leader. And since politics is not an exercise in objectivity, it is for this reason that several expected decisions by President Ramaphosa will determine how he will navigate between being regarded as a heroic figure and a victim of political persecution.

Objectively, it is hard not to agree with critics that a state of emergency will open the floodgates of collusion and corruption, which are distinct problems within South African public procurement. At this point, one wonders if this is not yet another gimmick to extend the patronage network of the presidency.

Another major decision facing President Ramaphosa is the much-anticipated cabinet reshuffle. Deputy President David Mabuza’s announcement that he resigned, only to be asked by the presidency to hang on, provides fascinating insight into how difficult it can become to exercise what some may regard as the mundane task of replacing cabinet ministers. And looking at the organisational footprint of the ANC, I reckon President Ramaphosa will avoid a situation where a cabinet reshuffle becomes another political hot potato from within his own organisation.

There is a fierce power war waging within the ANC. As a result, time will tell whether the president will be brave enough to replace poor-performing ministers instead of using proxies such as the new Minister of Energy. 

And to be clear – why we fail to confront underperforming ministers and public servants is a vexing question.

Indications are that there seems to be no aversion to brevity when it comes to political expediency, but to live up to the responsibility of accelerating structural reforms that significantly impact the country’s growth trajectory positively and reduce policy uncertainty. Continuing to routinely neglect these obligations is bound to create a more extensive trust gap between the government and citizens.

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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