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07 March 2024 Photo SUPPLIED
Gcina Mtengwane teaches in the Community Development Programme at the Centre for Gender and Africa Studies, University of the Free State, Qwaqwa Campus.

Opinion article by Gcina Mtengwane, Centre for Gender and Africa Studies, University of the Free State.


The notion that 2024 could echo the transformative spirit of 1994 holds weight. South Africans find themselves in a pressing need for positive social, economic, and political change. Yet, the avenue through which this change will manifest - a reformed African National Congress (ANC), an opposition party or a coalition government - remains unchartered territory. South Africa is on a downward trajectory. As various international indexes project corruption and poor governance, noting also that those indexes may not at times be accurate, the lived experiences of South Africans echo despair, disillusionment, and a betrayal of promises for a better life, particularly among the working class and the poor. 

The first democratic election in 1994 heralded an era where a new government had the opportunity to represent the interests and aspirations of all citizens, countering the discriminatory policies of apartheid. It fostered optimism for equal access to opportunities and life chances regardless of race, religion, gender, class, or ethnicity.

However, the transition to democracy, like any new venture, brought forth both opportunities and challenges. Actualising the vision of a ‘rainbow nation’ necessitated tangible legislative reforms and macroeconomic strategies beyond mere rhetoric. Consequently, initiatives such as the Reconstruction and Development Programme (RDP) in 1994, the Growth, Employment and Redistribution (GEAR) strategy in 1996, The Accelerated and Shared Growth Initiative for South Africa (ASGISA) in 2005, the new Growth Path in 2010, and the National Development Plan vision 2030 were implemented. While the efficacy of these macroeconomic frameworks remains contested, there is a consensus that more can be done and perhaps differently.

Parallels between 2024 and 1994? 

South Africa grapples with high unemployment, alarming crime rates, and an education system ranked among the world’s worst. South Africa is among the most unsafe countries in the world with an estimate of 27 494 murders recorded in 2022-2023. Ranked at 50th out of 63 countries, its education system is rated among the worst performing in the world. The education system fails to equip matriculants with practical skills for sustainable livelihoods. Additionally, funding exclusions and high dropout rates plague higher education, exacerbating the crisis. NSFAS has proposed defunding certain qualifications from its budget and half of those who do make it to universities drop out in their first year.  Moreover, South Africa measures the highest income inequality in the world, with a Gini coefficient of around 0.67, race being a key factor in a society where 10 per cent of the population owns more than 80 per cent of the wealth.

Persistent income inequality and deeply entrenched racial disparities are hindering the opportunities for upward social and economic mobility for the majority, notably the youth. The unemployment rate among youth, which includes persons between 15 and 35 years old, is around 60%. There is low support for and a high failure rate of start-up small to medium enterprises (SMMEs) with between 70% to 80% failing in the first five years of operations. There is a high rate of youth neither in employment nor in education or training (NEETs).  Data shows that 32.6% of graduates struggle to find work within the first two years of graduation, implying that for some, regardless of educational attainment, there is no optimism regarding the prospects for a better future.

The issues highlighted above are just some of the issues facing South Africa. These challenges underscore the urgent need for well-conceived and actionable solutions. A governing party must demonstrate clear policy direction and effective implementation mechanisms to uplift the most vulnerable while safeguarding the rights of all citizens, irrespective of race. However, certain radical policy proposals, like affirmative action and land expropriation without compensation, pose significant ideological divides.

Opportunity to nurture democracy

South Africa boasts over 30 years of democratic experience, providing invaluable lessons from past elections. There is a unique opportunity to nurture democracy and freedom, as is enshrined in the constitution, ensuring the well-being of current and future generations. The prospect of a coalition government looms large, potentially marking a historic shift. While unprecedented at the national level, coalition governance has been trialled in various municipalities including Johannesburg, Nelson Mandela Bay, and Ekurhuleni. However, these experiments often resulted in governance failures, characterised by instability and policy dissonance, rather than cohesive leadership. Political rivalry among the parties undermined service delivery and good governance, leading to the failure of coalition governance at the local government level.

Policy misalignment emerges as the key impediment to coalition success. The recent formation of the ‘Moon-shot pact’ underscores the necessity for aligned policy positions among coalition partners to avert governance crises.

Voter implications

Voting entails entrusting a political party with the responsibility to serve the interests of millions. It demands an informed understanding of the party’s policies as outlined in its manifesto. While individual charisma may sway voter preferences, informed decisions are imperative amidst South Africa’s challenges and opportunities. 

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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