Face to face with shadow health minister Siviwe Gwarube
Siviwe Gwarube, a rising star in the Democratic Alliance, is a key member of the parliamentary committee that will soon consider the National Health Insurance Bill. Spotlight is interviewing the main role players in the debate on this controversial measure.
On 22 May, while she was taking the oath as a new member of Parliament, Siviwe Gwarube’s eyes swept a packed public gallery, full of mothers, fathers, grannies, sons and daughters. But her mind was on her Uncle Mkhanyisi – who was not there. Mkhanyisi had died two weeks earlier in the village of KwaMdingi near King William’s Town, from where Gwarube hails. A father figure to her, he was supposed to be her guest on the big day. But he had contracted bronchitis, then fatal pneumonia.
“So that day at Parliament, obviously it was deeply emotional for me,” says Gwarube. “Standing there I said to myself: ‘I’m going to do this for you, Mkhanyisi, my man! I am going to do my absolute best.’ Because, you know, he was such a courageous man. He was an amputee and he had such a big personality. So, when I stood there to take the oath, I decided I am going to give everything I have and more to this job for the next five years, fully in his memory.”
From behind a large desk, Gwarube’s voice carries across her soft-carpeted office. She is barefoot, her black high heels waiting by the door. She radiates energy, a smile never far from her lips.
Women in leadership
Before our meeting, Gwarube visited Siphamandla Secondary School in Khayelitsha Site C, to drop off sanitary towels for 200 Grade 8 girls due to write exams. She paid for them from her own pocket – with the help of a few friends and colleagues.
On the subject of subsidised sanitary products for women in South Africa, Gwarube’s eyes glow: “How can poor female pupils concentrate on their education when they cannot afford to look after their bodies?”
She throws up her hands: “And you know what it is? We’re not making headway with things like this because we don’t have women in leadership. Women are not making the decisions.”
Outside Gwarube’s office, the parliamentary precinct is bustling. Finance Minister Tito Mboweni is delivering his Medium-Term Budget Policy Statement. Gwarube continues: “I’m going to challenge you to look at the picture of the people who emerge from this medium-term budget speech. The Finance Minister is usually accompanied by a cohort of people – and they’re men. Women are not in decision-making positions. And I’m not saying women should be pushed into decision-making positions. I’m saying women should demand to be there.”
Aged 30, Gwarube cut her political teeth at 22, when she was appointed spokesperson to then DA parliamentary leader Lindiwe Mazibuko. Since then she has served as Head of Ministry at the Western Cape Department of Health under MEC Nomafrench Mbombo and, in the lead up to the 2019 elections, she helmed DA communications.
“After my uncle’s death, when I returned from KwaMdingi to Cape Town for the swearing-in week,” says Gwarube, “I had to choose what portfolio I was going to ask to be placed in. I mean, I thought about land. And I was, like, ‘Oh, that’s going to be interesting.’ I thought about water and sanitation, because obviously having been the head of communications for the DA during the drought and Day Zero I had learned a tremendous amount about that. But then I also worked as chief of staff for [Western Cape provincial Minister of Health] Dr Nomafrench Mbombo for two years. So, I was like: ‘Look, you can do a lot of things. You are a very capable person – but what is it that you really want to do, where can you make a difference?’
“And so I settled on health, because, you know, one of the things I truly believe is that healthcare in this country is deeply expensive. My uncle wasn’t on medical aid when he died. And, I don’t know, maybe if he had received private medical care he would have lived? And 85% of the people in this country don’t have that option.”
Deliberating over the NHI Bill
In June, the DA announced Gwarube as their shadow minister of health. As a member of Parliament’s health portfolio committee, one of her key tasks is deliberating over the controversial National Health Insurance Bill, which was introduced to Parliament on 8 August.
“Parliament has its process,” she says. “Within 30 days of tabling the legislation they are meant to advertise and get people to participate.”
So far, the health portfolio committee has received more than 100,000 submissions. A special portal set up by the DA has received an additional 70,000 – although there might be overlap.
Gwarube has been spending her weekends at NHI public hearings around the country. Just before this interview, she’d been in Mpumalanga, visiting Nkomazi, Bushbuckridge, Thembisile and Ermelo.
“Parliament sends out notices to villages and townships and says come to this hall on this date and air your views,” she explains. “But the problem is that political parties simply bus in supporters. Then they pack these halls to the rafters and people get rowdy. Is that really a gauge of what public sentiment is? It becomes a political boxing match – the clash of the buses.”
These challenges aside, when the health portfolio committee has finished receiving and collecting public submissions, what happens?
“My next big fight will be that every single one of those submissions is read by the committee,” says Gwarube. “If it means we have to sit here day and night going through the submissions then that’s what we have to do. We don’t have the luxury of overlooking what people feel about this legislation. I mean it’s literally going to affect 56 million people.
“After that, we’re going to analyse the Bill, clause by clause. Obviously, there are many issues that we have identified and that’s where we should – theoretically – be able to amend certain things.”
As it stands, Gwarube has issues with the Bill. She insists she will not rubber-stamp legislation she believes is fundamentally flawed:
“The official DA stance is this: we support universal health coverage. What the ANC often do is to paint us as being anti-poor, anti-black, and all of these insults. Whatever, it’s Parliament and people jostle and grandstand. But it’s important, when it comes to law-making, that we separate the politics from it all. We don’t think the NHI legislation – as it stands – will achieve universal health coverage. In fact, we think it will completely destroy the system, which will certainly not improve the lives of people.
“Our concern is that the Bill proposes a centralised fund. And if you speak of centralisation in any context in this country … well, you are bound to fail. It will be open to corruption in a massive way,” Gwarube.
Healthcare is not like the SABC
“But healthcare is not like the SABC,” she adds. “When the SABC fails, somehow we are still fine. If this entity fails and is open to corruption, we’re in deep trouble. It’s literally a situation of life and death. We’re not playing games here.
“I’ve said to the minister [Zweli Mkhize], personally, and he can attest to this, I’m prepared to work with him to make sure that whatever comes out – the final Bill that comes out – is something that will improve the lives of South Africans.”
Gwarube points out that South Africa spends 8.7% of its GDP on healthcare – one of the highest such allocations in the world. She says the problem with South African healthcare is not funding – there are plenty of funds – it is corruption and inefficiency that leads to the squandering of these funds. Plus, systems that allow this to happen.
“We need a massive systemic health overhaul,” says Gwarube. “We don’t just need a simple funding model. And this is where the government of the day doesn’t understand the problem. We need to improve the health system in general, in its entirety. As it stands, the NHI simply speaks about funding. It doesn’t speak about accountability mechanisms. It doesn’t speak to how provinces are spending their allocated budgets. It doesn’t speak to how provinces have become almost chronically dependent on conditional grants.
“We sit here every year and we go through annual reports of departments and we see this on paper – not even through the lived experiences of people – how departments, provincial departments, are corrupt and failing people. What we’re trying to convey is that we’re not just being oppositional. We’ve done the work to put together a framework of what universal health coverage under the DA would look like. For starters, medical-legal claims would go down, meaning this money would go back into the pots.”
Gwarube adds that Parliament has become divorced from the reality of most South Africans: “I mean, the people I grew up with – they are the people I want to work for. And so, in retrospect, I’m grateful. I’m grateful for how I grew up. I’m grateful for the obstacles and I pray that I never lose that connection to the reason why I’m here.”
Growing up in a halfway house
Gwarube was raised by her grandmother, Veliswa, whom she refers to as her mum. Veliswa was an atypical woman at the time. A teacher, she did not feel compelled to get married after falling pregnant.
“She wanted to self-actualise and have a life of her own,” says Gwarube. “She did not feel as though she needed a husband to get the most out of life. Her son, my uncle, was always in the house; plus lots of people who were not related to us. You know, there were always other young girls who would come live with us. My mum would try and help them get some kind of post-school qualifications. So that was my family set-up; we were kind of a halfway house.”
Gwarube attended the prestigious Kingsridge High School for Girls in King William’s Town, commuting to class every day. This taught her about the duality of life in South Africa.
“My mum is passionate about education and that’s why I got the education I got,” she says. “And not because she had the money, because she literally sacrificed everything. This taught me empathy for kids who go to places where financially they don’t belong. The kind of thing a lot of South Africans don’t understand.”
After school, she completed a BA in law, politics and philosophy at Rhodes University in Grahamstown. This was funded through Veliswa’s pension, a bank loan and a National Student Financial Aid Scheme loan. The latter she is still paying off.
“If it wasn’t for the NSFAS loan, I would not have a higher education,” says Gwarube. “I’ve chosen the DA because it’s the political party most aligned to my own ideology. But, at the same time, I’ve also lived in an ANC-governed country for 25 years. And, despite their trajectory, which has been detrimental in many ways, there are instances where the ANC government has done well. And the NSFAS is an example.”
It was a dark moment when she could not continue her studies. There was no money left and the NSFAS did not cover postgraduate degrees. But, during her final year at Rhodes, Gwarube had joined the DA Young Leaders Programme – where she met her mentor Lindiwe Mazibuko.
“Lindiwe was, like, you should definitely apply for DA jobs when you see them advertised,” recalls Gwarube. “An advert came out while I was writing my exams in 2011, for a spokesperson role. I applied and was shortlisted. And they said, look, we would love to meet you, we’d love you to come to Cape Town. And I was, like, ‘Oh, I can’t afford to travel to Cape Town!’ I remember crying at home. I was, like, ‘Oh my God, I’m not going to get this job and I’m going to be unemployed’.
“Lindiwe said just be honest with them. So, I was and they said, that’s fine, we will interview you over the phone. Then I was, like, ‘Well, I’m not going to get this job because, you know, I’m obviously not going to be as impressive as anyone else they see in person’. Well, I got the job and started working for Lindiwe on 9 January 2012.”
In the big city
It was an early summer morning when Gwarube first arrived in Cape Town, stepping off the long-haul Intercape bus. She shakes with laughter at the memory: “Me and my suitcases and the Intercape bus. I was, like, ‘Oh my God! I’m in the big city!’”’
Friends in the DA programme helped her find a flat in Gardens. “And that’s how it started,” she says.
On a shelf behind Gwarube sits a box of lemon and ginger root tea. “I love tea, I’m such an old woman!” She laughs and reaches for a photograph, tilting the frame: “Hey, look, these are my friends!”
On the Rugby World Cup, she enthuses: “I am religiously following the rugby. I was sitting in a public meeting on Saturday, and we were playing Wales. Obviously, I was very committed to being in that public meeting, but I had to check the score.
“Siya Kolisi has got such an interesting story – again, a typically South African story. And, I mean, he’s a young man and he’s leading. There’s a misconception in South Africa; leadership is not just confined to political leadership or government. Young people are doing amazing things in different spheres. I mean, he’s one person doing an amazing job on the world stage – leading a team with all its complexities.”
Gwarube’s enthusiasm is infectious and, like her late uncle Mkhanyisi, she has a big personality. MC
This article was first published in Spotlight.