Dereliction of our health system now hurts us all

As SA traverses the rough seas of the Covid-19 pandemic, the cracks that have been caused by decades of government neglect, state failure and endemic corruption have suddenly become gaping holes in our health response to this crisis.

The SA government has presided over a broken health system for 26 years. It is a system that never enjoyed reform to cater for one of the world’s most unequal societies.

Adding salt to injury, foxes were awarded the lucrative positions of looking after the country’s hen house — our state coffers. True to form, money meant to reform and capacitate the health system over the years was stolen. Health facilities across the country were neglected, vacancies were left unfilled and unsuitable cadres were given top jobs to rinse and repeat.

When the storm came, the country’s shelter — the health system — was on its knees. People who have been perpetual victims of government neglect are now dying in various parts of the country because we cannot mount a decent health response to an unavoidable health crisis.

The two provinces that are now facing increasing numbers of infections and rising fatalities are the Eastern Cape and Gauteng.

Gauteng could have been better prepared for the pandemic wave that is about to hit if it had used the past four months effectively. The province had a couple of months’ head start to get its affairs in order before the impending peak.

It would have been expected that extra capacity in the form of intensive care unit beds, additional health-care workers and field hospitals would not have been ready for this crucial period.

However, if anyone needed a clear example of what years of dysfunctional governance and corruption look like, they would have to look no further.

The Eastern Cape has become the epitome of state failure. The victims will always be the people of this country and the health-care workers who have put their bodies on the line.

After weeks of horror stories about the healthcare system in that province, its flailing leadership and the scores of people who are becoming statistics, it was important to conduct an oversight visit to the province and ascertain the facts.

Meeting facility managers and hearing their struggle for the most basic equipment, like oxygen supply and personal protective equipment, it became clear that the province, with its current leadership, is beyond even cosmetic interventions.

Recently the country reached the 100-day mark of the national lockdown announced by the president. When the lockdown was implemented, there was a social contract that was implicitly signed by the government and its citizens.

Simply put, the executive required time to build health-system capacity and required South

Africans to stay at home while this was being done.

This, as 58-million people understood it, was to ensure that when the peak came, we would be able to be agile in our response.

Provinces such as the Eastern Cape have demonstrated that there has been a breach of this social contract. People remained in their homes and accepted the economic devastation that would come with that, but our government has failed to deliver on its end of the contract in many instances.

While the window of opportunity is closing quickly, the minister of health does have various options available to him to arrest the situation in parts of the country.

He can begin by placing the Eastern Cape under administration, according to section 100 of the constitution, which sets clear criteria for intervention where a provincial department cannot fulfil its core mandate.

Additionally, the government should rectify the funding crisis in provinces and give effect to the commitment made by President Cyril Ramaphosa to ensure that money is not an obstacle to saving lives.

The adjusted budget tabled in parliament two weeks ago short-changes the provinces by expecting them to make use of reprioritised funds from existing conditional grants.

Finally, financial resources must be attached to a coherent strategy that is underpinned by a commitment to testing and contact tracing in each province. Additional resources will mean little if the health systems in the provinces are not strengthened by competent operational and political leadership.

This crisis has demonstrated that corruption and poor leadership are not victimless. The victims are those fighting for oxygen cylinders in hospitals; health-care workers becoming infected with Covid-19 because of inadequate protective equipment; and those in rural areas who wait days for ambulances to come to their rescue.

Unlike the 26 years preceding this moment, when the government repeatedly failed South Africans, this time lives are at stake. How we respond to this crisis at this juncture will determine whether we win the fight against Covid-19.