It is a shame that inequality has become sharper during our constitutional democracy than during apartheid.
The tragedy that has befallen the Gauteng Health Department raises disturbing questions regarding how the department conspired with non-government organisations (NGOs) in a scheme that ultimately resulted in the death of nearly 100 mentally ill patients.
The health ombudsman’s report on the matter lays the blame squarely on the politicians, particularly former Gauteng Health MEC Qedani Mahlangu, who has subsequently resigned from her position. Mahlangu however maintains her innocence.
The issue is very complex. One side of the story is that the department sought to cut costs by terminating its relationship with Life Esidimeni hospital, which cared for those patients before they were moved to the NGOs. The report shows that the decision to remove patients from Life Esidimeni was not executed properly. The community based NGOs that received the patients were not ready to care for such patients.
The hasty way in which patients were removed from Life Esidimeni raise suspicions that the department wanted to cut the lifeline of Life Esidimeni hospital; a public-private partnership between government and a private healthcare provider.
I remember listening to Mahlangu on radio justifying the impending decision to remove patients from the centre. She then created the impression that the agreement between her department and the private hospital was unjustifiably milking the department coffers. This created the impression that Life Esidimeni was a bloodhound; only there to suck the life out of the Gauteng Health Department.
It is not surprising that the former MEC reached the hasty conclusion to pull the plug on the Life Esidimeni deal. I see this as an increasing suspicion that government officials tend to show towards public-private partnerships where government enters into an agreement with the private sector to provide institutional services to the people.
Because such agreements involve risk sharing and pooling of resources between government and private companies, they tend to be inherently more open and transparent than agreements where government simply goes out and procure a service and pays for it.
Public-private partnerships are entered into because government on its own would not have the resources or capacity to provide a particular key service to the people. Then private companies are brought in to raise money and build the infrastructure through which it would provide a service. Government would then buy the service under such an agreement.
Because the private sector does not want to be excessively exposed, it shares the risk with government and at times government have to provide financial guarantees in case there are financial problems during the course of the agreement.
This complex system of providing services requires a proper feasibility study, including a sound budgeting process, to ensure the project is planned for properly. Under this type of agreement, kickbacks are not too common.
The truth is that politicians do not like this type of agreement. They often mischaracterise it as a vehicle for private companies to amass huge profits from government’s lack of capacity to provide key services. Politicians forget that the very reason these types of agreement are entered into is because government does not have the capacity to provide the key services in the first place.
The decision by the Gauteng Health Department to cut ties with Life Esidimeni comes from this unfounded suspicion that the latter was making lots of money from the public coffers, and probably not paying any kickbacks in the deal.
It is unfortunate that pulling the plug on Life Esidimeni meant pulling the plug on the lives of nearly 100 patients. The department’s cost saving measures were achieved at the expense of its core responsibility to provide a decent health service to those patients.
Audit reports would come out well for the department, while the basic services would have been compromised. This is a tragic situation that indicates that government should not be judged only in terms of the cost saving measures it undertakes. It should be judged in terms of the extent to which cost saving measures improves the quality of services.
In this specific matter, the cost cutting measures were sinister and vindictive, only aimed at stroking the ever growing egos of politicians.
- Ralph Mathekga is an independent political analyst and author of the book When Zuma Goes. He writes a weekly column for News24.Disclaimer: News24 encourages freedom of speech and the expression of diverse views. The views of columnists published on News24 are therefore their own and do not necessarily represent the views of News24.
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