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Prof Anthony Turton
Prof Anthony Turton is a water expert from the Centre for Environmental Management at the University of the Free State.

Opinion article by Prof Anthony Turton, Centre for Environmental Management, University of the Free State. 


South Africa and Australia, both arid countries with historical ties to the British Empire, face significant water management challenges. Despite common legal and parliamentary systems, the two nations diverge in their approaches to water sector governance, leading to markedly different outcomes in economic prosperity.

In examining the disparities, it becomes evident that contemporary South Africa is grappling with a scenario resembling a failed state, particularly evident in the breakdown of the electricity and water services sector. This raises a fundamental question – why is the South African water sector faltering while its Australian counterpart thrives? 

Why is the South African water sector collapsing?

Addressing the collapse of the South African water sector requires a nuanced understanding rooted in historical context. The origins of the issue can be traced back to the British Empire’s consideration of federalism during the Anglo-Zulu War. While federalism found success in Canada and Australia, it failed to take root in South Africa.

Fast forward to the present, South Africa operates as a unitary state with a centralised water policy and national water law. This uniform approach leaves little room for local variation, resulting in a cookie-cutter model applied nationwide. Despite water being a constitutional right and given that free basic water is guaranteed to all, the sector faces challenges such as high levels of unaccounted-for water, leakages, and poor management. The absence of justiciable water rights and the separation of water from land ownership hinder private sector involvement. Consequently, utilities are reliant on government bailouts, a situation exacerbated by failing water and electricity grids, diminishing the tax base, and escalating unemployment. 

Australia’s flourishing water sector: A model of innovation 

Australia’s federal structure facilitates a diverse array of state policies and laws, promoting adaptability to local conditions. Boasting over 30 distinct water authorities, each tailored to meet local needs, Australia thrives on a justiciable water right system that allows private ownership. Market forces drive water to its most productive use, and investor confidence is a cornerstone in decision-making. 

Australia’s innovative and market-oriented approach has resulted in well-managed utilities with robust balance sheets. The ability to raise capital from the bond market reduces reliance on public funds for bailouts. Groundwater plays a vital role, accounting for around 40% of the total resource, while innovative technologies, such as seawater desalination, are embraced at the utility scale.   

South Africa’s water sector: uninvestable and facing challenges 

Contrastingly, South Africa’s water sector faces challenges. A lack of innovative approaches, coupled with a rigid, cookie-cutter methodology has stifled local imagination. The state’s hostility towards private capital has rendered the water sector generally uninvestable. While some large water boards still maintain strong balance sheets, the growing debt burden from non-payment by municipalities poses a threat. Limited development of groundwater at utility scale, coupled with a reluctance to replicate successful initiatives, further compounds the challenges. Sea water desalination, where it exists, is confined to small package plants in distressed municipalities along the coast, often seen as unsustainable. 

Australia’s innovative solutions: integrating technology and conservation

Australia stands out for its innovative solutions. With a vibrant private sector driving constant technological advancements, groundwater is a key element in most utilities, actively integrated into the grid and accounting for around 40% of the total resource. Building codes align with water conservation, ensuring rainwater harvesting and aquifer recharge are actively pursued at various levels, including suburb and city. The management of sewage, increasingly sophisticated water recovery from waste, and seawater desalination at utility scale funded by private capital showcase Australia’s forward-thinking approach.  

Centralisation versus decentralisation  

In conclusion, the weakness of South Africa’s water sector lies in the highly centralised approach, resulting in ineffective, one-size-fits-all solutions. Local authorities often lack imagination, relying heavily on taxpayers and hindering innovation. Suspicion towards capital and technology further limits the sectors development. In contrast, Australia’s decentralised approach fosters vibrant water utilities capable of attracting both capital and technology. Entrepreneurs’ initiatives in desalination and water recovery programmes inspire investor confidence, leading to capital influx and secure, water-efficient local economies.

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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