From next month the Eastern Cape Department of Health will have a new boss, who will have to sort out several major problems. The department is bankrupt. Its tertiary hospitals are hollowed-out shells of what they used to be. The province is in the grips of a third wave of Covid-19 cases and the Bhisho bureaucrats are holding on for dear life as the department sinks under the weight of years of mismanagement.

And yet the first female superintendent-general of the department, Dr Rolene Wagner, is upbeat.

It took the Eastern Cape government close to a year to recruit someone for the job that was vacated by Dr Thobile Mbengashe, who resigned before his contract ended after a disastrous Covid-19 response, mounting legal claims against the department, a top-heavy bureaucracy with many leadership positions at hospitals left vacant and the scandal of the medical scooters that were almost bought with Covid-19 money.

Finding someone who was part miracle-worker, part exorcist, with a knowledge of the intricacies of the Eastern Cape Department of Health’s administrative structures, with supernatural patience and armour of steel seemed impossible. But then Wagner said yes to the job.

As we spoke, she was preparing handover files for her successors, and as one of life’s indestructible optimists and enthusiasts, she seemed eager to come home to her beloved Eastern Cape.

A veteran of the Bhisho administration, Wagner, who was recruited by the private sector a few years ago, holds a number of degrees, including a Masters in Public Health Administration from the University of Fort Hare, an MPhil in Public Health (cum laude) from the University of the Western Cape and an MBChB from the University of Cape Town.

“There is no better time than the present for leaders in society to raise their hands and step forward to serve. The worst times are often the best times to make bold decisions; because it is in the face of the greatest challenges that we are forced to reflect and find new ways of doing things,” she said.

“On a personal level, I was brought up during a time of social conscience, where it was instilled in me that it is proper and noble to help others. I have been blessed to have a very supportive family who ensured, through great personal sacrifice, that I was educated at the best public schools and universities they could afford. They instilled in me a set of values that includes humility, respect for others and the need to work hard, always raising the bar and encouraging me to be the best at whatever I set my heart and mind on.

“I believe I have an obligation to use the knowledge, experience and skills passed on to me to serve those who, due to our history, may not have had the same set of circumstances as I have been fortunate to have. Much of my career and work experience has been honed by teachers and colleagues in the public sector, predominantly in the Eastern Cape. If we are facing unprecedented times, then all who have had a hand in shaping me would expect nothing less than for me to step forward and step up,” she added.

A favourite story told about Wagner was how, when the Department of Health had stalled on installing a new facility at Port Elizabeth Provincial Hospital to treat babies with congenital heart disease for many months, she quietly came to Gqeberha and met many distraught moms. She sat down and talked to them. She sped up plans. Warded off possible public interest litigation. Made alternative arrangements and got the job done as far as she could. Without raising her voice once.

She has always been a brave leader. When she was the CEO of Frere Hospital she turned the hospital into an international benchmark and won awards for her exceptional leadership.

In 2017, she was presented with the Jakes Gerwel Award for her and her team’s transformation of Frere Hospital “from a place where babies go to die into a hospital which is now nationally recognised for its achievements”.

The award recognised her successful campaign to turn the hospital into a patient-centred site of excellence.

“These achievements include a measurable improvement in patient safety with significant reductions in mortality and morbidity,” her citation for the award read.

“Frere Hospital’s annual crude death rates have come down by 26% in the past four years and, in the last two years, mortality has been the lowest since 2004. Successful implementation of key quality improvement projects have also made a difference. For instance, four years ago the waiting time in the pharmacy outpatients’ unit was four to six hours; it is now under 45 minutes. In-patient radiology waiting times have been reduced from 10 days to 24 hours.

“The hospital prides itself on its ability to innovate as a means to mitigate systemic public health challenges and to improve clinical and corporate governance. Key amongst these is the development of an open-source, electronic health management system. 

“In addition, Frere Hospital was the first public hospital to launch a website and Facebook page as a means to engage with clients. Dr Wagner also ensures that every positive patient experience that is reported is shared directly with the staff who were involved in the care of that patient.” 

Another accolade recognised the “remarkable turnaround” that transformed Frere Hospital, once notorious for its high infant death rate and delayed medical attention, to one of six hospitals that won recognition at the World Hospital Congress in Brisbane, Australia.

She led this turnaround in five years. Now she might have to do it again — but she has a plan.

“There are three immediate challenges, from an operational perspective, that I will need to tackle on taking up office: addressing the financial situation so that basic services can continue to be provided and the outflow of funds due to medico-legal settlements stemmed; containing the Covid-19 third wave resurgence and mitigating future surges by rolling out the vaccine programme; and engaging and supporting our healthcare workforce whose efforts, especially in the last year, have been magnificent in the face of the onslaught of the pandemic and significant budgetary constraints,” she said.

“On the clinical service delivery side, we do need to ensure that critical primary care programmes like HIV and Aids; TB; maternal, women and child health; and chronic diseases management get back on track. We will need to reconnect with our patients and communities to ensure they are compliant with treatment; and to screen for early detection and management of these conditions.

“I am also passionate about using information and communication technology to enable and advance service delivery, making healthcare more person-centred and accessible to communities. So I will be looking to accelerate the implementation of our eHealth programme, amongst other homegrown innovations.

“Whilst I do have thoughts on what needs to be done and how this could be done, I will be engaging with key stakeholders in the months ahead so that we can emerge with a shared vision, a focused team and a practical implementation plan on the way forward. I intend building on the existing capability within our department and will continue working with our social and strategic partners to augment our efforts,” Wagner said.

While one CEO has described making peace with doctors in the public sector, who have suffered the brunt of administrative abuse in the past few years, as being akin to “hugging a wounded lion”, Wagner said she will address their concerns.

“Firstly, I would like to acknowledge the magnificent and heroic efforts of our doctors and all healthcare workers in responding to the Covid-19 pandemic; and also appreciate all who supported them in their efforts to treat really ill patients. As doctors we are trained to save lives; but in the context of such high demands for critical care this was, regretfully, not always possible. Doctors had to make the unfortunate decisions on how to utilise the available resources optimally, and were thus not always able to treat everyone as they may have wanted to.

“Dr Wagner is just what the department needs and we are happy she is back with us after she was stolen by the private sector. With her leadership skills and knowledge of the health sector, working with senior management, organised labour and workers, we are sure she will excel.

“In addition, many healthcare workers were infected and affected by Covid-19, not to mention the toll that working extended shifts had on their physical and mental health. Words cannot adequately express the depth of admiration and appreciation we all feel for the healthcare professionals and workers, and the partners who assist us during these challenging times.

“I would like to give clinicians a voice through structured clinicians’ advisory forums so that they are able to give input into the design and delivery of clinical services. They are an important stakeholder in our efforts to ensure that we provide the best, safest and most cost-effective care to our patients, and that everyone has a positive experience of their care at our facilities,” she said.

But how will she handle the department’s biggest issue: billions of rands in medical legal claims that are eroding significant shares of the annual operating budget?

“A lot of groundwork has been laid by the Office of the Premier, Provincial Treasury and Health, regarding dealing with the medico-legal issues. At the time when I was the deputy-director general for hospitals and clinical support services management, the department had commenced the development of the eLiability system to assist in quantifying and tracking medico-legal claims.

“I will be meeting the project teams that have been set up to coordinate the legal, financial and health service delivery interventions. There are several interventions planned and in various stages of operation. Once I take up office, we will communicate on these efforts.”

Wagner will be leaving her post as the medical director of Netcare’s Primary Care Division to join the Eastern Cape Department of Health.

“I was privy to the structures and systems of the private sector that I believe will be useful in our development of the National Health Insurance,” she said. 

“To mention two that spring to mind, the first is the system of alternative reimbursement models introduced by funders to promote value-based care. Providers are reimbursed according to whether they have provided for certain core services; and the extent and cost of that service compared to their peers. Top-end performers receive a higher remuneration band than those who were outliers beneath the targets set by the funders. Whilst we do not operate on a for-profit basis in the public sector, the notion of deriving value for the investment made in providing healthcare is relevant to both sectors.

“The second learning is about the ordering and billing systems in a primary care setting that allows every item utilised in a primary care facility to be recorded and accounted for — in terms of quantity, but also in terms of cost.

“I also learnt that every new service is planned down to the smallest consumable and needs to demonstrate a return on investment through a feasibility assessment before it will be funded.

“That being said, I also learnt that the private sector also has its own set of challenges. The number of persons with medical cover is decreasing whilst the cost of providing care has been increasing above inflation, year on year. The pandemic and state of the economy have exacerbated this trend. Being effective and efficient is thus vital if a business is to survive and thrive.

“I think that both sectors would benefit from close collaboration as each has strengths that the other can learn from,” she concluded.

Wagner’s appointment has been welcomed by Premier Oscar Mabuyane and the MEC for Health in the province, Nomakhosazana Meth.

“Dr Wagner comes with a wealth of experience as she led Frere Hospital with distinction for years as its CEO before taking up a position as deputy director-general: hospitals and clinical support management services,” Meth said.

“Her appointment comes after a lengthy recruitment process following the resignation of former head of department Dr Thobile Mbengashe last year. No better person could have been appointed. 

“Dr Wagner is just what the department needs and we are happy she is back with us after she was stolen by the private sector. With her leadership skills and knowledge of the health sector, working with senior management, organised labour and workers, we are sure she will excel.

“We have all seen what she can do as she turned Frere Hospital around and now she will have that same energy and innovativeness for the entire province. We wish Dr Wagner well in her new responsibility,” she said. DM/MC