When Dr Thobile Mbengashe (65) arrived at the Eastern Cape department of health in September 2013, he received a baptism of fire. During his first week on the job, the department’s superintendent-general had to receive a petition from a hostile crowd of thousands of activists from the Eastern Cape Health Crisis Action Coalition. The protesters were led by activist Mark Heywood and trade unionist Zwelinzima Vavi. They had marched from Bhisho Stadium to his office, charging that the province’s health services had collapsed. “That was my reception,” recalls Mbengashe. “It was very clear that there were major issues in terms of how people were experiencing health services. So, my first job was asking how we could turn things around.”And he has done just that. His department has received an unqualified opinion from the Auditor-General for the past two years in a row – a first for the Eastern Cape. Mbengashe is planning to provide new services to residents. These include introducing cancer treatments and specialist doctors in rural areas.In addition to his medical degree, the father of four holds a diploma in child health and a specialisation qualification in family medicine. Driven by his interest in public health, he has added a master’s degree to his list of qualifications.To fix the province’s near-defunct health services, Mbengashe set up rapid response teams of managers, who were sent to districts and clinics to solve problems.“Every team was given full authority to look into what was going on and deal with the issues promptly,” he said. “The second issue, which is really important to me, was about governance – building systems.” On assuming office, Mbengashe soon learnt that the budget had been “inappropriately” spent. The audit reports were shocking, thanks to governance, systems and controls that were either nonexistent or ineffective. He tackled these problems by empowering lower-level managers to make decisions and intervene in real time. The results speak for themselves. “Getting an unqualified audit in 2016/17 for the first time in 12 years was big. We had to follow that up and get another. We have had unqualified audits for two years now – the first time in the Eastern Cape.” How did he achieve this? By doing simple things, such as filling the many vacancies at senior management level, examining the irregular expenditure that the Auditor-General’s office had uncovered and implementing audit improvement plans.Using new technologyNow he plans to digitise the province’s public health sector and automate the system so that those systems governing finance, human resources, supply chain management and information can be better coordinated.“For instance, it is difficult for us to get specialists in far-off places. We have a number of maternity services and want those to be fully connected so that a specialist at Dora Nginza Hospital in Zwide township is able to communicate with one at Livingstone Hospital in Port Elizabeth. This way, we can provide support to patients and staff in remote places,” he says.“We also want to improve the quality of services by using the new technology.” An oncology unit is on the cards for Nelson Mandela Academic Hospital in Mthatha, which has no cancer treatment services – forcing patients in the former Transkei to travel to Frere Hospital in East London for treatment. “We want to conduct outreach services so that these oncology treatments are available in all our district hospitals,” says Mbengashe. There are also plans to provide chemotherapy at all the province’s major hospitals.Mbengashe says it is a problem in that district hospitals are underutilised. There are many empty beds as patients prefer to seek treatment in cities where there are specialists.“We are considering a number of strategies to bring specialists to the people in their rural hospitals,” he says.“One of our exciting strategies is so-called air doctors, where you hire aircraft that land on a sports field. You take these doctors and specialists to those rural hospitals. They work there all day and, when they are done, you fly them back.”Another reason district hospitals are underutilised is because the roads leading to them are in poor condition. Mbengashe says the provincial government has prioritised fixing roads leading to hospitals. To facilitate doctors’ travel arrangements, each district hospital will have six beds where doctors can sleep.The department has solved the issue of student doctors sent to study medicine in Cuba, only for them to return and refuse to work in rural hospitals. Those loopholes in their contracts have been closed, says Mbengashe. The department is expecting more than 390 Cuba-trained doctors to return and serve at least two years in rural hospitals before being allowed to work elsewhere.Mbengashe, born in Alexandria and raised in Port Elizabeth, says his relationship with Health MEC Pumza Dyantyi – a doctor herself – is one of mutual respect.“The MEC is hands-on. We share the team. When we have meetings, she is part of them and she contributes. That has been extremely useful,” he says.