In September 2013 Dr Thobile Mbengashe was appointed as the superintendent-general of the Eastern Cape Department of Health as civil society put pressure on the provincial government to appoint a permanent head of the department.

At the time the department saw a succession of acting superintendents-general without anybody wanting to accept the job that was seen as almost impossible to do.

Mbengashe was handed the poisoned chalice. A great burden of hope was placed on the shoulders of the soft-spoken man with the superb bedside manner, power to convince, the quick laugh and the precise, enunciated way of speaking.

Seven years later, to the day, on Tuesday he resigned from his job to take up a position as an adviser to Premier Oscar Mabuyane, leaving a department with crumbling infrastructure, struggles to access medication, massive supply chain problems, critical human resources issues, the management of many hospitals in tatters and emergency medical services that were idling on the edge of disaster.

Mabuyane announced Mbengashe’s resignation in his weekly Covid-19 update.

“On behalf of the provincial government, I want to thank Dr Mbengashe for his service to the people of our province. It was not the first time that he served the people of our province. He has served in various capacities, including in the liberation struggle, where he was actively involved in fighting apartheid. We thank him for his service because he used his skills, wisdom and expertise to serve the people of our province during his work at the department. He supported the province in the development of our provincial multisectoral HIV and Aids strategy through the Eastern Cape Aids Council.

“His skills and expertise will be of use in a different capacity from now onwards as I have appointed Dr Mbengashe as one of the special advisers to the premier. He will be playing a strategic role of advising me on how we can continuously improve the provincial administration going forward. The good work we have done in the fight against Covid-19 is because we had him and his colleagues at the helm of the administration and strategic arm of the Department of Health. We appreciate the contribution he made on that front,” Mabuyane said.

Quick to admit the failures of the administration and slow to fix what was ailing it, Mbengashe, as the accounting officer for the Department of Health, also leaves behind a department with R3-billion in unpaid bills.

Medico-legal claims had ballooned to R29-billion. Following an energetic period of emergency procurement in his department due to the Covid-19 pandemic, he also leaves as the Special Investigating Unit announced a probe into 239 cases in the Eastern Cape Department of Health involving R622.4-million.

… on Tuesday he resigned from his job to take up a position as an adviser to Premier Oscar Mabuyane, leaving a department with crumbling infrastructure, struggles to access medication, massive supply chain problems, critical human resources issues, the management of many hospitals in tatters and emergency medical services that were idling on the edge of disaster.

Faced with the rampant increase of medico-legal claims in his department, Mbengashe had appointed himself as the health ombudsman but failed to address many of the issues.

In many respects, the writing has been on the wall for Mbengashe since 2019. Earlier this year the premier announced that some of the department’s budget would be taken over by the provincial treasury. The administration of medico-legal claims was moved during Mbengashe’s tenure to a special unit at the premier’s office. The operational handling of the Covid-19 crisis was handed to the special project management unit created by Mabuyane after a highly critical report to the premier and the Minister of Health, Dr Zweli Mkhize, highlighted fatal and shocking shortcomings in the province’s hospitals.

After a disastrous initial response to the Covid-19 pandemic that saw an angry Mkhize lose his cool about the department’s slow response, Mbengashe managed to persuade President Cyril Ramaphosa during a visit to Port Elizabeth in April that all was well.

Apologising, making promises and expressing confidence that all was now under control, in a masterclass of presentation he assured the president that the provincial health system was working as it should.

But the faultlines were already uncovered. As hospital staff went on strike, hospitals, especially in the busy Nelson Mandela Bay metro, came crashing down with only the dedication of a group of doctors and nurses standing between patients and disaster.

Subsequent investigations showed that the emergency medical services plan was hopelessly inadequate and the province was facing an oxygen-supply crisis. At the Mthatha regional hospital, doctors admitted during a webinar that 10 patients had died during the pandemic when they ran out of oxygen.

“This was no way to run a hospital,” Mbengashe admitted in an interview about the ongoing leadership crisis at Livingstone Tertiary Hospital. The hospital is currently on its seventh acting CEO, with efforts to find a permanent one only commencing after the scathing project team report was sent to Mkhize.

During his tenure, no less than four hospital CEOs were removed from their positions after they clashed with union members. These hospitals were Livingstone Tertiary Hospital where the entire management team led by Thulane Madonsela, a man who was headhunted by Mbengashe, was removed; Dora Nginza Hospital, Elizabeth Donkin Psychiatric Hospital and Fort England Psychiatric Hospital.

Faced with the rampant increase of medico-legal claims in his department, Mbengashe had appointed himself as the health ombudsman but failed to address many of the issues.

Remarking on this pattern, Judge Andre van Niekerk stated in a judgment of the Labour Court: “Instead of reining in the unlawful behaviour of the unions and union officials and holding them to account for their actions, Mbengashe… and the provincial department of health, ultimately engaged in what can only be described as appeasement and acquiescence and ultimately, craven capitulation to the unlawful demands by the unions to have the applicant [Dr Roger Walsh, who was the CEO of Fort England Hospital at the time] removed from his post.

“In these circumstances, when an employer allows itself to be held hostage to a concerted campaign of violence and intimidation conducted by power-hungry union officials, the basis for any semblance of a system of industrial relations is compromised. In the resultant anarchy, for those citizens who are reliant on the services provided by the department of health, life will literally and inevitably run the risk of being reduced to the Hobbesian description of life without state structures and controls – ‘solitary, poor, nasty, brutish and short.’ So it was for the hospital’s patients, to whom the constitutional right of access to healthcare is owed, and who have suffered as a consequence of the conduct of the unions and their officials and members.”

Responding to Mbengashe’s resignation, the Democratic Alliance’s Jane Cowley said now that he is going to serve as the premier’s adviser his first job should be to advise the premier to fire the MEC for Health, Sindiswa Gomba.

“The Democratic Alliance has repeatedly called upon the premier to remove Mbengashe as the head of the health department. On his watch over the past eight years, the department has suffered several ills including R29-billion in contingent liabilities due to mostly medico-legal claims, hundreds of vacant funded posts that have remained unfilled while the savings are channelled to pay medico-legal claims; the resultant chronic understaffing has left healthcare workers stretched beyond their limits and often the sick are sent home unattended, or the reduced quality of care has resulted in further claims against the Department of Health.”

She said Mbengashe allowed a once effective EMS service to splutter to an almost complete halt through centralisation, chronic understaffing and continued shortages of appropriate EMS vehicles.

“He has abused his position of authority to place cadres and friends in senior positions within the department that they are not qualified to hold and whose performance has left a legacy of incompetence and institutional incapacity across the province.

“The premier has announced that Dr Mbengashe will join his office in an advisory capacity. This move breathes life into the adage that one should keep one’s friends close, but one’s enemies closer. The first piece of advice Dr Mbengashe should give the premier is that he should remove the MEC for Health, Sindiswa Gomba, and replace her with somebody who has the requisite capacity for the job. Her appointment shows us all that political patronage is far more important to the premier than any concerns for the health of the people of the Eastern Cape.”

Thoko Mtsolongo, from the Eastern Cape Health Crisis Action Coalition, representing civil society organisations that work in the province’s health sector, said they welcomed the resignation of Mbengashe.

“Under Dr Mbengashe’s leadership, while there have been some improvements in financial management and audit outcomes for the Eastern Cape Department of Health, the reality for health service users has been dire. The department has repeatedly failed to provide adequate healthcare for people across the province. Hospitals have been dysfunctional, clinics have fallen apart, ambulances have simply failed to arrive.

“Since 2013, when Dr Mbengashe took up his position in the province, the Eastern Cape Health Crisis Action Coalition has advocated an increase in the number of ambulances in the province, for better planning for in addressing the human resource challenges the province faces, and for improvement in health infrastructure. There has been little or no improvement, and in some cases, a severe deterioration in services. The province has the lowest treatment coverage for people living with HIV and clearly insufficient community health workers.

“The province’s management of Covid-19 under Dr Mbengashe’s leadership has been disastrous, with the near-collapse of district health services in Nelson Mandela Bay and the ‘scooter’ tender scandal, in which R10-million was irregularly allocated to procure vehicles that Health Minister Zweli Mkhize said ‘do not meet the basic criteria for patient transport as an ambulance’.

“Given this record, we are concerned by the premier’s statement that Dr Mbengashe will now play the role of special adviser to the premier.

“We call on the premier to appoint a suitably qualified candidate, who is beyond reproach, to replace Dr Mbengashe as a matter of urgency. The province cannot afford a leadership vacuum in a department which has already been brought to its knees during a global pandemic.

“Strengthening the Eastern Cape health system requires sound leadership at both political and senior administrative levels. Dr Mbengashe’s departure should not be seen or understood as a quick fix that will result in major improvements. The Eastern Cape health system requires widespread reforms, including action to ensure that committed health civil servants are supported while underperforming civil servants are held to account and face real consequences for their role in creating dysfunction,” she said.

Mxolisi Dimaza, the chairperson of the Eastern Cape Legislature’s Health Committee, said that they were shocked by Mbengashe’s resignation.

“We have not been informed of the reasons,” he said.

“We have to appreciate the fact that Mbengashe when he came brought stability to the department in a number of respects. He did bring about a change in how the department would account to the portfolio committee. But as the head of a big department like the department of health one needs to have someone who will apply consequence management consistently – we were worried that this was lacking. As far as that was concerned it was a serious weakness. This caused a number of things to happen. Whoever will be coming in his place must focus on improving mental health facilities in the province. Even he will agree that he never resolved this properly,” Dimaza said.

“He didn’t have much support. The managers in the department failed him. He tried to defend them but they continued to fail him. To the committee, the human resources department remained a weak link. We wish him well. He worked well with us. Let us be honest that him leaving will not make it a better department. There are serious problems there that are not going away with Mbengashe.” DM/MC