Two of SA's most dysfunctional provincial health departments lack progress, leadership, capacity or vision, says outgoing health ombudsman Prof Malegapuru Makgoba.
Reflecting on the end of his seven-year tenure on Wednesday, the country’s first health ombudsman pulled no punches. He said the Eastern Cape health department was an “embarrassment”, and Gauteng’s health department was “problematic” and “changed its CEOs [like] panties”.
The Free State health department, added Makgoba, was characterised by “disorder and no harmony”. Makgoba, who described his office as independent and not beholden to any political party, said the only province that “seems to have got its act together is the Western Cape”.
Of just more than 10,000 complaints his office had received, half were from Gauteng, which he said was run like Eskom and lacked stability due to frequent changes of top leadership, resulting in poor service delivery.
Makgoba said an investigation into Rahima Moosa Mother and Child Hospital in Gauteng found that “the criteria for appointing the leadership of hospitals is the weakest”. His office also found the hospital to be unsafe, filthy, neglected with crumbling infrastructure and disrespectful to patients.
“How do you expect hospitals to have CEOs that have such low criteria when this should be the thoroughbred of the system? If you go and have Mickey Mouse CEOs running the hospitals? The most attention of many people in South Africa is around Gauteng. I mean, this is the showcase province. You have your best province run by Mickey Mouse ... what do you expect?
“You expect what you are getting ... a service that is in shambles. A service that doesn't really deserve what it is.”
While there is no comparison between Gauteng’s wealth and Limpopo’s, Makgoba said Limpopo had a stable leadership and one MEC (Dr Phophi Ramathuba) for a long time.
“So there is stability about the leadership in Limpopo that doesn't exist here. Here they change CEOs like, I don't know, panties or whatever it's called.”
He warned the Gauteng health department to reconsider its position. “There is a problem in Gauteng, and I think they should just be very careful about that. Try to get some stability and be better.”
During a 2018 investigation of Tower Psychiatric Hospital at Fort Beaufort in the Eastern Cape, which revealed neglect, abuse of patients, dysfunctional management and no accountability at either the hospital or health department, he discovered there were no relationships between health professionals and the provincial health department, something that resulted in patients suffering.
Further investigations by the Public Protector and Office of Health Standards Compliance (OHSC) into Eastern Cape hospital found similar problems to Gauteng, including frequently changing hospital CEOs.
“There was very little connection between the health professionals, the nursing staff and physicians. And the only thing that suffered there were the patients. I think the Eastern Cape provincial health department is really an embarrassment, but that's for the minister to deal with at some point,” he said.
Makgoba said while his office often faced appeals and legal challenges, in the past seven years none of those had succeeded and his findings had not been overturned by any court.
“I think this is testimony to the quality of the investigators and the investigations that we do. The principle of quality is measured by the reports that you produce that are overturned by the courts.”
He said being independent was one of the principles of his office, and staying impartial was crucial. Makgoba said he had never been influenced by any of the three health ministers he served under, nor had they interfered with his work.
“I bring this point because political interference and political manipulation is a very common phenomenon in South Africa. Sometimes these interferences or manipulations don't take place in formal ways.”
Makgoba said he was departing having made a difference in the lives of South Africans.
One of the most striking investigations was into the Life Esidimeni debacle where 144 psychiatric patients died in Gauteng due to neglect after being moved from a private facility to NGOs, some of which were unregistered.
While no-one has been imprisoned so far as a result of the tragedy, Makgoba said there were consequences with several senior officials, including former health MEC Qedani Mahlangu, either losing jobs or having their reputation in tatters. Families had also been compensated for the ordeal their loved ones went through.
He said an inquest in the North Gauteng High Court would hopefully make pronouncements on whether anyone was criminally liable for the tragedy.
“Let's wait for the judge who has listened to all the evidence and the arguments to pronounce what judgment he has. But there have been consequences ... there has been some form of accountability, and there has been some responsibility that people have taken. It may not be what we want ... and you may not agree with people, but we don't have to be angry with them.”
