Political Accountability: Denied
“It’s a luscious mix of words and tricks
that let us bet when we know we should fold.”- James Mercer
Gauteng Department of Health, under the management of former MEC for health (Member of the Executive Council) Qedani Mahlangu, transferred approximately 1300 psychiatric patients, from Life Esidimedi to at least 27 NGOs (Non-Governmental Organisations). As a result of patients being moved without proper planning and to unlicensed and ill-equipped facilities about 100 psychiatric patients died. The Minister of Health instructed the Health Ombudsman, Dr. Makgoba, to investigate the circumstances surrounding these deaths. The Health Ombudsman released his report containing damning findings on 01 Febuary 2017.
How did it happen?
In this case (as is with all government related conduct) a distinction between Public Office Bearers and State Administration which constitutes Public Service Officials is necessary. Public Office Bearers (elected in accordance with a system of democratic government) have different powers and functions from public service officials. Public Office Bearers are responsible for participation in policy processes and are accountable to the respective legislatures and the public whereas public service officials are, in contrast, responsible for executing legislation and policies. It must also be remembered that although these have to be distinguished they cannot be separated as the one is dependent on the other and vice versa.
The decision to transfer patients in itself was not illegal as this is provided for as part of the Deinstitutionalisation policy. Deinstitutionalisation is the corner stone of the Mental Health Care Act (2002) and as such the Gauteng Marathon Mental Health Project (GMMHP) was launched to deinstitutionalise mentally ill patients into community based care. It is undoubtedly clear that the decision itself was not the problem but the implementation thereof.
Further investigations revealed more discrepancies in stewardship- such as the fact that the licensing process was unlawful. Unauthorised officials signed documents without proper delegation; NGOs were issued with licences without being properly inspected for compliance and no screening criteria was followed, as prescribed. The Premier stated on various occasions that the executive council was not consulted in this matter.
Political and administrative accountability boils down to the obligation of Public Office Bearers and government officials to act in the best interests of society and when disobedience is exhibited Public Office Bearers and officials should face the consequences of their misconduct. As seemingly uncomplicated as this seems, political accountability in practice is rigorously more challenging to accomplish than accountability of officials under employment law.
The state and all of its departments and official bodies have to follow labour legislation, like all other employers as per Labour Relations Act and the Constitution. These legislations clearly stipulates that every person, irrespective of how wrong/illegal the conduct was, has the right to a fair disciplinary process. This, not unnecessarily so, complicates the matter of accountability. This is also the reason why many disgruntled citizens seem to think that nothing is being done to apprehend the guilty party(s). Or why it seems that no one is being held accountable.
There is an urgent need to review health care legislation(s) to harmonise and align different spheres of government. Centralisation of certain functions and powers of certain pieces of legislation (like MHCA) must revert back to the National Health Minister. This just confirms that both the public and the government realise that the health system is in need of reform towards a more unified solution driven system.
Good policies that are inadequately implemented, or not implemented at all,- coupled with weak or no managerial capacities to oversee implementation lead to poor results. There has been insufficient political oversight and leadership to manage underperformance in the Gauteng Department of Health. There has also been a stubborn tendency to retain incompetent senior staff. As a result, for many years, loyalty—rather than an ability to deliver—has been rewarded among Public Office Bearers and public servants and there has been no climate of accountability. A more efficient public sector requires the political determination to solve the problem of capacity, to deliver public services, and to change the culture of the public service from one that is oriented towards security of employment and reward for loyalty to one focused on accountability and delivery of services to the public, in which competence and performance are both expected and rewarded. Without concerted efforts to change national thinking on accountability, South Africa will become a country that is not just a product of its past, but one that is continually unable to either address the health problems of the present or to face future challenges.