Instead of delays and platitudes from officialdom, the “I Am” movement is demanding a response from elected representatives. As workers on the ground in South Africa’s public healthcare system, they say they need to hear from the Premier of Gauteng, David Makhura and Minister of Health, Dr Joe Phaahla, with concrete plans to address concerns raised in their open letter submitted a month ago. The letter calls for an end to the victimisation of whistle-blowers and for systemic changes that will place decision-making power with properly constituted boards and CEOs who are primarily accountable to the hospital, its staff and patients rather than detached head offices.

The campaign grew out of solidarity with the wake-up call that paediatrician Dr Tim de Maayer published in an open letter about the abysmal state of Rahima Moosa Mother & Child Hospital, where children’s deaths would be preventable if hospital administrators did their jobs. For whistle-blowing, De Maayer was suspended. He was only reinstated after an immense public outcry – though once he was back at work, he was forced to apologise and was given a warning.

Dr Aslam Dasoo, who is one of the “I Am” movement’s signatories and the convenor of the Progressive Health Forum, emphasised the scale of the crisis that public healthcare is facing: “The issues canvassed in the letter are widespread around the country, not just in Gauteng. And so it behoves them to understand that this is a national crisis. Simply meeting with the nation and saying, ‘Okay, we’ll fix up your little hospital over there, or we’ll refurbish that part of the hospital’ is not enough, there needs to be a systemic change.”

The campaign is cautiously optimistic about a meeting that took place on 11 July where some of South Africa’s most senior and respected figures in healthcare advocated for the demands of the open letter. 

“The ‘I Am’ delegation, led by Prof Rudo Mathivha, head of ICU at Chris Hani Baragwanath Academic Hospital, is comprised of a senior clinical head from each of about 20 hospitals across Gauteng, including all the major tertiary academic complexes, as well as the Dean of Wits School of Health Sciences, Prof Shabir Madhi. These senior clinicians collectively represent the fullest spectrum of the public medical professional cohort in Gauteng who make up the core of the ‘I Am’ movement.” said Dasoo 

Makhura and Phaahla did not meet these senior clinicians. Instead, they sent functionaries to represent them. 

According to Foster Mohale,  spokesperson for the National Department of Health “The first instance of engagement with the group has been initiated through the meeting between the clinicians with the Acting Provincial Government Director-General and new HoD of Provincial Health department.” 

These appointed officials lack the kind of decision making power necessary for the kind of urgent, systemic changes needed in the healthcare system. No substantive decisions were made and no timelines were created at the meeting. 

“The Premier and Minister haven’t as yet met the ‘I Am’ movement, however, have acknowledged the letter and its contents.” said Mohale.

Vuyo Mhaga, the Gauteng Premier’s spokesperson, told Maverick Citizen that there was an agreement with the healthcare professionals but that further engagement with other stakeholders is necessary. 

“Safe to say, there is a conversation and the meeting was quite positive. The two parties will actually work together to resolve some of the issues that they are speaking about.

“It’s not an issue that we can agree and implement overnight because it does not only affect the clinicians, it affects obviously the workers in those hospitals, it affects the nurses in those hospitals who might not necessarily be part of the group that is complaining… As you will appreciate, there are also other stakeholders like labour that the Gauteng government authorities must also meet.”

Other categories of health workers such as nurses, pharmacists and therapists, have also signed the open letter. 

Dasoo is wary of endless meetings with no action. 

“Even in the previous meetings [around a separate issue of addressing the damage from the Charlotte Maxeke fire in 2021], there’s a lot of acknowledgement. ‘Yes, no, this should be done. We agree with this. We agree with that.’ But then nothing happens after the meeting, because of the arcane kind of arrangements in the government… I think that there’s a national and provincial issue here. Who’s in charge of what? And so everything falls through the cracks.”

Mhaga said that the Gauteng provincial government was already working on some of the issues that were raised in the letter because they were priorities that were outlined earlier this year. He said: “If you go and read the State of the Province Address around health and you read [the open letter], you’ll find that there’s a correlation between what the Premier said and what the clinicians are saying.”

Though there are some vaguely shared priorities around issues like hospital maintenance, the 2022 Gauteng State of the Province Address does not make reference to the kind of systemic changes that the open letter is calling for. For example, while the open letter calls for a fundamental restructuring of the process to appoint hospital CEOs to make them more accountable, the State of the Province Address merely expresses satisfaction that most CEO posts in the province have been filled.

Mohale said that the Premier and Minister “have understood the issues as systematic and requiring reforms of the health system in the province, and have begun to address them through the Provincial Strategic Support Team”. 

Because the movement is still awaiting substantive commitments, Dasoo said “We wanted to escalate this matter. And not in a confrontational way. You’ll see the letter doesn’t really berate them, it puts the issue clearly, it acknowledges that there was this meeting, but it insists that the campaign requires an escalated response now and from the politicians themselves.

“Health workers and professionals have found their voice through the ‘I Am’ movement and it marks a permanent change in the power relations between faceless administrators with their unacceptably poor stewardship and the health worker cohort who keep the doors to care, often under great duress, open to the people. 

“This change in the power relations must now be translated into policy, including reviewing the delegation of authority to health facilities that currently resides with inchoate provincial administrative centres.”

Mohale said that the next meeting “should happen in the near future or sometime in September, but there will be numerous follow-ups that the DG and HoD will be having.” DM/MC

Here in full is a follow-up letter from the ‘I Am’ Movement addressed to the Minister of Health Dr Joe Phaahla and Gauteng Premier David Makhura:

An Open Letter, signed by 135 of SA’s leading health professionals and health workers, despatched on June 21, 2022, conveyed their dismay and outrage at the victimisation of Dr Tim de Maayer and other health workers and professionals who have spoken out about the intolerable conditions in public health services.

Their repeated pleas for urgent interventions to prevent debility and deaths of patients arising from deficient provisioning and management have been routinely ignored by an administration whose only response has been to intimidate and threaten disciplinary action.

We were encouraged when the Premier’s office eventually responded and arranged to meet with a group of senior clinicians from Gauteng health facilities on July 11. The assurances given by the assembled officials to address the matters canvassed in the Open Letter are cautiously welcomed, despite the absence of any official commitment to specific demands.

Consequently, we take this opportunity to apprise you of the current iteration of the “I Am” campaign generated by the Open Letter.

The one hundred and thirty-five signatories to the Open Letter have now been joined by almost seven thousand health professionals and health workers, supported by three and a half thousand South Africans, from across the country, all concerned with the state of public health services and in full agreement with the contents of the Open Letter.

Link here to the Change.org petition.

If ever any validation of the contents of the Open Letter was required, we commend to you this massive endorsement.

It should leave you in no doubt of the views and determination of health workers, supported by the people to whom they owe their duty of care, to continue with this campaign until a decisive response from the government is forthcoming.

Health professionals and health workers are the lifeblood of the public health system. There are only so many of us. We are beholden to the people to whom we have sworn an oath, not to a disinterested and often callous administration, so listen to us when we advocate for our patients.

Your positive response to our call will signal your compliance with the constitutional obligation to provide universal access to healthcare for all who live in South Africa, which can only ever be delivered by a revitalised and high-performing public health service.

The “I Am” Movement, July 25, 2022

This is who we are. The names of the thousands of healthcare workers who signed in agreement with the “I Am” Movement’s open letter. DM/MC