Sunday Times E-Edition

Q&A

In the wake of the health ombudsman’s devastating report on Rahima Moosa Hospital this week, CHRIS BARRON asked Wits University health-care governance expert professor ALEX VAN DEN HEEVER how it was allowed to happen ...

To what extent is the national health department to blame for the collapse of this and other public hospitals?

Many hospital CEOs were appointed by the national minister. Second, the governance framework for these hospitals has been determined by the national department, not by the provinces. That’s a large part of the problem because it allows incompetent CEOs to be appointed and retained. So this problem is not just a provincial one.

At what point can and should the national department intervene?

One always assumes that national should be sending in a team and doing something. What happens then is that they don’t change the structure. They don’t interfere with any of the key political players who have been responsible for the collapse.

They put the Gauteng department of health under administration, didn’t they?

That was in 2015. Some kind of team was sent in and achieved absolutely nothing.

Why?

Because it leaves everything intact, it leaves the accountability structures in place that are causing this. The accountability structure is about who ends up in a leadership position over health-care services, and how they’re held to account.

Are you saying there’s nothing stopping national from getting directly involved in ensuring accountability at provincial level?

Not directly involved, but they can establish at national level certain requirements. For instance, supervisory boards, including how they’re appointed and removed, and their powers to appoint and remove hospital CEOs. The Rahima Moosa CEO was appointed by health minister Aaron Motsoaledi, who was responsible for appointing 100 CEOs across the provinces, many of them extremely problematic.

But never held to account?

There’s no structure for doing that. The provinces never developed their own. If you look at Rahima Moosa, the province has not been evaluating the performance of the hospital, going in and checking and saying: “If you don’t correct this you go.”

Aren’t MINMEC meetings [of ministers and MECs] supposed to be a forum for national to find out what’s going on and intervene if necessary?

It’s not a matter of just meeting. You have to have routine performance reports and be reacting to those reports.

And that’s not happening?

Try to find the performances of public hospitals anywhere on the national department of health website. You won’t find anything. National’s responsibility is to monitor what’s going on, and if something’s not working … it has national policy implications if hospitals are failing and they should intervene.

How?

Identify the systems that are not working and require that they are put in place. That’s what they’re not doing. Systems of accountability are very important. If they’re absent or weak it allows a lot of discretion to turn a blind eye to stuff when it’s politically OK.

And so we get a Tembisa or Rahima Moosa?

The head of Tembisa is still on suspension after months and months of brutally blatant transactions all approved by the CEO. The same at Rahima Moosa. A CEO who didn’t pitch up for work and thought life would be so much easier without patients. That was her attitude for years and the province took no action.

Opinion

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2023-03-19T07:00:00.0000000Z

2023-03-19T07:00:00.0000000Z

https://times-e-editions.pressreader.com/article/281994676728017

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