So Many Questions: On deaths of 94 mentally ill patients

Administrative incompetence by the provincial health department led to the deaths of 94 mentally ill patients in Gauteng. Chris Barron asked Minister of Health Aaron Motsoaledi...

Does this give you confidence in the ability of public health officials to run the National Health Insurance scheme?

Oh, yes. It does. For the NHI we want to change a number of laws that presently give powers to provinces to act alone.

Won't it be dependent on the same officials?

Yes, but when they act under a different structure, a different dispensation, you might be able to control some of them.

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They'll still be incompetent, won't they?

If you read the report of the ombudsman it was not an issue of lack of capacity or ability, it was just some form of intransigence. There were enough experts in the system who were advising.

The patients they sent to NGOs never received their government stipends or food or blankets. That's administrative incompetence, isn't it?

NHI is there specifically to solve problems like this.

How will it if it's run by the same people?

There are 55-million South Africans. If there are any health officials who are wrongly placed now we can correct that in order to run NHI. It doesn't mean there are no people in South Africa able to run NHI. That would be a very wrong view.

So where are they?

I am working with a lot of health officials who I have a lot of confidence in, and they give us very good advice.

Why aren't they in Gauteng?

Well, they're there. They are there.

So how could this tragedy have happened? What are they doing there?

If you read the report you will see the number of health officials and experts who were advising against this.

Doesn't it say that the top health official, the head of the health department, was one of the chief orchestrators of the disaster?

Yes, but he's not a typical representative of all South Africans. He's one person. Why are you talking like he is a representative of all that South Africa has got? He's not. He's an exception. 

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He's head of health in Gauteng. Surely the kind of person you're going to be depending on to run NHI?

No ways. The fact that Gauteng appointed a person who ends up being wrong does not mean the whole country is going to be like that. I reject that. You want to say all health officials in South Africa are like that. They definitely are not.

If you've got such good health officials why aren't they running health in the provinces?

Well, you are aware that in the present rules I don't participate in who is being appointed to run health in the provinces.

If the national department can't influence the administration of health in the country, then isn't it a waste of taxpayers' money?

NHI, if you look at some of the policy proposals which are going to go into the act, is specifically to correct that. We are saying that if this is a national health insurance then it must be national, it can't be provincialised. Even the issue in Gauteng, if you look at the recommendations of the health ombud, he's saying we need to review the 2002 act so that the powers are brought back to the minister. Because they were taken away in 2002.

So that was a big mistake by government?

Oh yes, it was.

Isn't NHI going to be another big mistake?

No, I reject that. The concept of NHI is not only something that is being started in South Africa, it's in countries all over the world.

But they have competent people to run it, don't they?

Yes. But we have competent people in the country.

Where are they?

They're around the country. Are you saying the country consists of fools?

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Wouldn't you say most of our competent healthcare managers are in the private sector?

That's why NHI wants to use both.

Isn't the tragedy in Gauteng a strong argument for outsourcing NHI to the private sector?

No, we're not outsourcing NHI to the private sector. We want to use both public and private. That's the whole essence of NHI.

What about the culture of excuses, lack of consequences, lack of accountability? Is this what we're going to get when things go wrong in NHI?

Are you saying there's been a lack of consequences in Gauteng?

The MEC, Qedani Mahlangu, wasn't fired, was she?

She resigned before that could happen.

Should the MEC have been fired?

The premier announced that he was going to take that action if she didn't resign.

Isn't there an important difference between being fired and being allowed to resign?

Yes, well, there is a big difference, but the premier said he was going to do so in terms of the recommendation.

Why is the head of the health department still there?

The report did not say "fire", it said the correct processes must be followed.

Why are correct processes only followed when it's too late?

That's a brilliant question — that processes are not followed by officials, but when it comes to them, they want processes to be followed.