The last few weeks were big weeks for South Africa for accountability and governance. There were at least three events, or pieces of writing, on accountability that made me sit up and think. (This week we are all trying to hold the national government and Eskom accountable. But let’s talk about that at another time.)
Last week Neva Makgetla wrote a noteworthy opinion piece on corruption and accountability in the public sector for Business Day. If you have a subscription, you can access it here. She wrote about how the public sector has, since apartheid days, had a culture of secrecy and protection of information. And that this very culture has persisted and is what contributes to corruption and the lack of accountability. If government were a house, there would not be big clean windows which allow the light in and enable people outside the house to see what is going on inside. Rather, if we believe Neva Makgetla, we can imagine government employees mostly spending their days in a dark place with only a few small windows.
She also wrote about weak protection for workers who are willing to knock out the walls of this dark house and let the light in. The whistleblowers. Let’s call them the guardians of light. She writes that rather our government has chosen to centralise accountability and anti-corruption efforts through regulated procurement and staff appointment decisions. A choice to put top-down accountability above bottom-up accountability.
During the last few weeks, Judge Raymond Zondo handed over the third and final report from the proceedings of the Zondo Commission to the Presidency. Like the previous two reports, the third report makes for shocking and deeply concerning reading.
However, the piece of writing that made me truly hopeful last week was not an opinion piece or the report on a government-appointed commission. Rather, it was a letter written by a group of very concerned healthcare workers.
Dr Tim De Maayer, a pediatric gastroenterologist who has spent his career working in the public sector when he has other options open to him, wrote an open letter about the deeply concerning conditions at the Rahima Moosa Mother and Child Hospital. He wrote this letter after he had communicated his concerns through the proper channels and did not receive an appropriate response. He was initially suspended from his position and only reinstated after a public outcry. Once back in his position, there were reports of his victimisation.
The letter gave me hope about a growing sense of accountability and responsibility for the health system, at all levels of the system. It was written in support of Dr De Maayer and called for an end to his victimisation. The writers of the letter range from senior academics, managers and some of the most senior managers in the health system, deans university health faculties, former heads of provincial health departments, and so the list goes on and on. It was an unprecedented event for a sector that has been accused of typically turning inward and protecting its own people.
The following point from the letter really struck me: “Conditions of service that prohibit health personnel from speaking publicly on these deficiencies are reminiscent of apartheid-era practices to stifle rightful dissent and public disclosure and are contrary to the constitutional order”.
The health system is different from other social delivery systems like education or housing. The consequence of poor performance or dire conditions can be death.
Investigations such as the maternal mortality audits try to contribute to a no blame culture so doctors and other healthcare workers can freely share about the conditions that give rise to a mother’s death. This is not always easy if workers in the health system have not been taught to talk about hard stuff, the conditions they work in and their own mistakes too.
A 2015 study on the National Health Service in the United Kingdom found that that up 3.6% of deaths in hospitals were “avoidable”: things that were done wrong, or not doing things right. We don’t have such comprehensive, similar studies for South Africa. Here it (as in other places too) it would be hard to distinguish between the human error of a single healthcare worker and those of a system, the conditions that perhaps led to the healthcare worker error in the first place.
There are many workers in the South African public sector and in the health system who care deeply about how they spend their time. Teachers, nurses, doctors, policemen and -women, social workers. The list goes on and on. We need transparency in all areas of social delivery. But even more so in the health system where system failures could mean the loss of life.
Transparency, letting the light in both from the inside and the outside, should be the corner stone of a system where the consequence of bad conditions and poor performance are death. Where families can lose their beloved parents, sister or brother or children.
Let’s support letting the light shine in. We need to create a better system for all who work in it and who rely on it. South Africans deserve to have health systems (public and private) that they can feel proud about.
Views expressed are the writer’s own.
