Maybe it's time to get a new health minister

2018-06-10 06:02
Health Minister Aaron Motsoaledi. (GCIS)

Health Minister Aaron Motsoaledi. (GCIS)

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Maybe it is time that we remind Aaron Motsoaledi (pictured) that he has been our health minister for an uninterrupted nine years. In this period, he has spoken a lot. One must also remind him that he was a health MEC in Limpopo. All in all, he has occupied executive office for no less than 20 years since the dawn of democracy. We need to get a return on our investment. But, more importantly, we must remind him that, before him, we had two health ministers, both of whom were medical doctors – so it is not the first time we have a health minister who is a medical doctor.

By far, Nkosazana Dlamini-Zuma, as the first post-apartheid health minister, had the most difficult task. Save for the Sarafina! issue, she performed her duties with distinction. Today, we have what is clearly the opposite of what we had at that difficult time.

Eight years ago, we heard much about the National Health Insurance scheme. It was as if we were heading to a world-class health system. As we are still waiting for what is clearly a pipe dream, the state of the system is deteriorating at an alarming rate.

In the midst of all this, I cannot tell whether we have a health minister or not. I often see a gentleman on television complaining all the time. It seems that the issue of the powers and functions of provinces deprives him of sleep.

Then entered the Health Ombudsman, a seasoned medical expert who ventured into the arena of constitutional law. His wisdom, like that of the minister, is that the minister is constrained by the Constitution. My memory may be failing, but I cannot recall Dlamini-Zuma ever moaning about powers and functions. She introduced fundamental changes in the health system under the same Constitution. Now this Constitution is inhibiting her successor.

The fallacy that the minister cannot do anything about the unfolding crisis is a dangerous proposition. More than anything, it appears calculated to shift responsibility.

South Africa has three spheres of government. Deliberately, the powers and functions of each sphere are clearly defined. Nowhere in the Constitution is the minister precluded from ensuring that the other spheres exercise their powers and perform their functions. On the contrary, the Constitution provides for various checks and balances to enable the minister to ensure compliance.

Section 41(h) of the Constitution enjoins the spheres of government to coordinate their actions and to adhere to agreed procedures. Those familiar with the basics of government know that it is for this very reason that there are coordinating structures between the spheres of government that share functional areas. The minister is in law the chief coordinator by virtue of his position. Organisational structures of departments always mirror this important coordinating role that national government plays.

Section 100 of the Constitution enables national government to intervene in one of two ways when a province fails and/or is unable to perform its functions. This makes national government the supervisor of provincial government.

The pieces of legislation that regulate the core functions of the various sectors define the roles and responsibilities of the spheres of government at operational level.

For instance, national policy matters are allocated to the minister. I still have not heard one health MEC demand to have these policy functions. Inherent in this is that the national department is involved in the planning and budgeting processes. It cannot claim ignorance of what provinces have to get and then what they do with what they get.

Based on the chief coordinating function of the national department – which ranges from policy, planning, budgeting and monitoring to evaluation – why do we always hear about how disempowered our health minister is? What exactly is the minister not doing, in terms of his powers and functions, that deprives him of the ability to perform this very important overarching function? Do we have to assume that the minister is precluded from knowing the operational details of provinces and, if so, who is this person or who are these people undermining our minister?

The coordinating structure, called a MinMEC, is a statutory intergovernmental body chaired by the minister and attended by all nine MECs and their top officials. Maybe we should ask what is discussed in these meetings, if they even take place. I find it hard to believe that these meetings do not take place, but I suspect that their coordination may just be out of this world. It is hard to believe that, if the minister has complained in public about his powers, this matter has not been discussed by the MinMEC.

It is hard to believe that, after the Life Esidimeni tragedy, which he disowned, it was not discussed in the MinMEC. Are we to believe that the health sector has no agreed procedures, or are they being disregarded with impunity?

Last year, the minister, exercising his powers in terms of the National Health Act, gazetted the norms and standards for healthcare facilities. An Office of Health Standards Compliance was established. Do we assume that provinces are precluding the office from carrying out its duties and that nothing is being done about it?

Interestingly, the department, in its annual report, states that its goal is to “achieve a health system that works for everyone and produces positive health outcomes”. This may sound far-fetched, having regard to the Health Ombudsman’s statement that our health system is on the verge of collapse.

If it is on the verge of collapse, did our constitutional arrangement contribute to it? The health system did not collapse under the former health ministers under the same Constitution.

The sector will always be under pressure. The pressure did not start, nor will it end, with this minister. It is exactly why we have a national health minister, and Motsoaledi must deal with these pressures. Amending the Constitution to give more to someone who already has wide powers will not address the real problem. Maybe it is time to appoint a new health minister. It seems the vision of a health system that works for everyone is still a pipe dream. We need someone to make this real.

- Mannya is an advocate and a former public servant

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