On 7 October, Gauteng Premier Panyaza Lesufi appointed Nomantu Nkomo-Ralehoko to be the new MEC for Health and Wellness in Gauteng. She replaced Nomathemba Mokgethi, a health MEC who was largely missing in action, since she was parachuted in to replace the disgraced Dr Bandile Masuku in 2020. 

She is the eighth MEC for health in 10 years.

Nkomo-Ralehoko takes over at a time when the Gauteng health system faces multiple crises. At first glance, she does not appear to have any knowledge of or experience in managing complex health systems (see this profile of her political career that appeared in the Sowetan), so her qualifications for the appointment are not clear. 

However, in announcing her appointment, Lesufi motivated it on the grounds that because “health is under tremendous pressure” (mentioning senior clinicians wanting to leave and Tembisa Hospital as examples), “it needs a senior leader in the ANC to be deployed there; that’s why we appointed the deputy chair of the ANC in Gauteng province”. 

Lesufi added: “We are serious about health. Hospitals must not be the way they are now. We are starting with [fixing] the hospitals in the townships, as part of our broader township development agenda. We want to see a 360-degree change.”  

People queuing all day “must be history”, he said, and also the “attitude of staff members towards our patients”.

In addition in his speech (listen to his speech here from 4.19), Lesufi identified the following health issues that he considers “non-negotiables”:

• The portfolio is being renamed “health and wellness” so as to put more emphasis on preventing disease and illness: “we are very worried people only arrive at hospital when they are very sick”.
• The province is putting an “information management system” together “so people know whether beds are available in hospitals before they go there”.
• In keeping with the emphasis on prevention there will be a “strong regulatory arm”, particularly of “fake and expired foods that are circulating in the market”, mentioning levels of sugar and salt; and also better education about health “within the schooling environment”, including about food.

One of the reasons for appointing Nkomo-Ralehoko, Lesufi said, was that as the former MEC of finance she would be able to tackle issues such as poor financial management and the overpricing of goods. 

“This must be the department that pays service providers within 30 days. If you don’t pay, you don’t get services; if you don’t get services people don’t get quality,” he declared.

Ominously, but without any elaboration, Lesufi also complained about “the majority of people who are accessing our services, who should not be accessing services” — presumably a reference to migrants in Gauteng. 

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Gauteng to get a government pharmaceutical company 

One surprising aspect of the announcement came when, in the context of introducing Jacob Mamabolo as the new MEC for finance, Lesufi announced the Gauteng government’s intention to establish a (provincial) pharmaceutical company.

“We are going to buy medicine on our own directly. We don’t want to buy medicine via a third party who will go to China and bring it back. 

“The new mandate of the finance department is to establish a pharmaceutical company where we will buy medicine in bulk directly. There must be no hospital or clinic without medication, and the finance department is going to manage that.”

Finally, on the subject of health Lesufi promised to tackle the scourge of the drug nyaope, promising to take addicted children to a farm for six months for rehabilitation. Lesufi complained that although “NGOs have been dealing with this thing, it’s continuing”. He promised that “the department of health will give medication … the Department of Education will assess them. We will send them to school and carry the bill.”

Asked for comment about the proposals, one senior health worker in Gauteng, who asked to remain anonymous, had the following to say about the appointment:

“It doesn’t augur well to get health sorted in Gauteng, more so when the premier is naive about the province buying its pharmaceuticals from a state-owned pharmaceutical company, remarks which are manifest in its shallowness of the actual challenges faced in the public sector, and seemingly ignorant of pharmaceuticals in general.”  

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Unfinished business 

But, before the new MEC tackles the premier’s agenda, there is some urgent unfinished business she will need to tackle, including:

• Quality of hospital care: The serious issues raised by Prof Tim De Maayer in his open letter have not been addressed. Instead, the CEO of Rahima Moosa Mother and Child Hospital is believed to have been on sick leave since the controversy around De Maayer’s open letter, brief suspension and reinstatement in late May.
• Criminal investigation into the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) fire: as revealed by Maverick Citizen, it is now known that the SAPS believes the cause of the fire was arson. Further criminal investigation was recommended. However, in a letter to the Progressive Health Forum on 20 September, Lesufi, while still the acting premier of Gauteng, admitted: “The Office of the Premier has no knowledge of further investigations conducted by any institution after the forensic report by the SAPS.” Until there is a statement from the SAPS to the contrary it seems the investigation has been abandoned.
• Corruption: There are several ongoing investigations, including by the Special Investigating Unit (SIU), into corruption in the Gauteng Department of Health (GDoH). The chairperson of the Gauteng Ethics Advisory Committee (GEAC), Terence Nombembe, told Maverick Citizen that the GEAC “is in the process of engaging with the departments in Gauteng, Health included, with a view of making meaningful advice that will root out corruption, particularly in the GDoH.” Nombembe adds that the fire at CMJAH “is one of many specific situations that GEAC is tracking and will provide advice on”.
• Three months after it was handed to the President, the SIU’s final (“supplementary”) report into its investigations into Covid-19 corruption, which includes its investigation into several Gauteng hospitals has still not been made public; meanwhile, at least nine senior officials in the Gauteng departments of health and infrastructure development remain suspended on full pay. DM/MC