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13 February 2024 Photo SUPPLIED
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.


President Cyril Ramaphosa’s 2024 State of the Nation Address (SONA) has, as expected, drawn mixed reactions. The speech placed strong emphasis on addressing significant sources of discontent and division within the country, such as gender-based violence, unemployment, crime, load shedding, poor service delivery, and corruption. The speech underscored the President’s commitment to economic reform and job creation through initiatives such as the Presidential Youth Employment Intervention

At a time when South Africa is on the eve of national and provincial elections, where the youth hold immense potential to shape the outcome – if the registrations can translate into voting – it is interesting to note that the President’s approach of using the analogy of young ‘Tintswalo’ has drawn considerable debate.

‘Tintswalo’ and President Ramaphosa’s soft-line approach

While the President’s approach in utilising the positive life trajectory of Tintswalo – a young girl born in democratic South Africa – may have been intended to inspire hope and showcase progress for many since the end of apartheid, critics argue that it overlooks the persistent challenges that many young citizens still face. But is focusing on a single success story providing a misleading impression of the overall state of the nation and downplaying the continuous challenges South Africa faces?

Public opinion can vary, and different individuals and groups may have different perspectives on the nation’s current state. For many, the ANC-led government has created a nurturing environment through various policy interventions, and a system of social transfers geared towards sustainable and productive investment in citizens. This view was supported by the World Bank, which described the country’s policies and programmes for the poor as ‘effective, well-targeted, and providing sizeable benefits to the poorest households.’ 

Indeed, the post-apartheid environment and individual agency enabled today’s Tintswalos to prosper. These deliberate programmes and policy interventions provide an environment that fosters educational attainment, instils values, and encourages personal growth. However, it is important to acknowledge that not all young people have equal access to resources and opportunities.

President Ramaphosa did not appear harsh, but rather dignified in using political persuasion to convince the world of the government’s resolve to strive for equitable access to education, health care, and social services to ensure that all young people have a fair chance to prosper. 

And, of course, relying on political persuasion is not hard. 

The President, an advocate of the soft line approach, has perfected the art of smothering citizens with embraces – smothering that has lately been peppered with the phrase: ‘ba rata kapa ha ba rate (whether they like it or not), we have done well.’ He did not appear harsh each time he uttered this phrase, but dignified in the conviction of the achievements of the government he has been leading since February 2018. However, the effect of the Tintswalo analogy – accentuating the state’s weaknesses rather than obscuring them – is the opposite of what was intended.

The bottom line is that the number of unemployed, politically disengaged, and disgruntled youth is growing, as is their ferocity.

Shrinking fiscal resources and the central role of institutions

As South Africa achieves a significant 30-year milestone of political freedom, the protection of individual freedoms and the establishment of institutions to safeguard democratic values stand as noteworthy achievements. However, amid the celebrations, shrinking fiscal resources and the overarching impact of increasingly reduced budget cuts for the higher education sector will hamper the progress of a new generation of Tintswalos. It has repeatedly been proven that education is an essential pillar of a country’s economy.

In Why nations fail: The origins of power, prosperity and poverty, Acemoglu and Robinson underscore the significance of inclusive economic institutions. They argue that countries differ in their economic success because of their different institutions, the rules influencing how the economy works, and the incentives that motivate people. 

Consider for a moment the difference between teenagers in North and South Korea.

According to these scholars, those in the North grow up in poverty and know that they will not become prosperous due to the propaganda they are fed in school. Those in the South obtain a good education, with incentives encouraging entrepreneurial initiative and creativity.

In South Africa, one of the most disheartening anomalies of our nation’s state is the blatant failure to ensure consequential management for the recurring unauthorised, irregular, fruitless, and wasteful expenditure by municipalities and state institutions reported by the Auditor-General. This is indicative of political power that is exercised arbitrarily.

In steering its future development, a South Africa that embraces diversity, prioritises economic recovery, invests in education, and leverages the incentives provided by state institutions will ensure equitable access to services and opportunities and allow all young people a fair chance to prosper, regardless of political affiliation.

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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