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SPOTLIGHT

Who will be SA’s next health minister? The ball’s in the ANC’s court, but here’s some options

Who will be SA’s next health minister? The ball’s in the ANC’s court, but here’s some options
Cyril Ramaphosa and Joe Phaahla at the public signing into law of the National Health Insurance (NHI) Bill at the Union Buildings on 15 May 2024 in Pretoria, South Africa. (Photo: Gallo Images / Frennie Shivambu)

After the ANC received less than 41% of the vote in last week’s national elections, negotiations are under way to determine how and by who South Africa is governed. Spotlight considers the candidates for minister of health.

For most of the past 30 years it went almost without saying that the country’s health minister would be drawn from the ranks of the ANC. But given the dramatic decline in the party’s electoral fortunes and the consequent pressure to enter into coalitions or other deals, the pool of realistic candidates for the post might this year be larger than before.  

The President has the prerogative to appoint any members of the National Assembly as ministers, whether or not they are from the same party as the President. The President can also, at his or her discretion, appoint two ministers who are not members of Parliament. It is also relatively trivial for a party to ask an MP to stand down and to have another sworn in, as happened with Minister of Electricity Kgosientsho Ramokgopa. This means that candidates who were not high enough on party lists to get seats in Parliament could still be substituted in. 

Although technically the pool of possible health ministers is thus quite large, political realities narrow down the choices considerably. 

Let’s start with candidates from the ANC, given that odds are still that our next health minister will be from the party. 

Minister of Health Joe Phaahla during a National Health Insurance (NHI) briefing

Minister of Health Joe Phaahla during a National Health Insurance (NHI) workshop. (Photo: GICS)

First in line is South Africa’s current health minister, Dr Joe Phaahla. He is not on the ANC’s national candidates list, but he is high up on the party’s regional list for Limpopo and thus set to become a member of the National Assembly. Though some might describe his time as health minister over the past three years as uninspiring, he also hasn’t been implicated in any scandals or made any obvious blunders. 

It might well be that President Cyril Ramaphosa, presuming he stays in the job, sees Phaahla as a safe pair of hands and considers him the right person to drive the ANC’s stated goal of preparing for and starting the implementation of National Health Insurance. Phaahla previously served for some years as Deputy Minister of Health. 

rural healthcare

Deputy Health Minister Dr Sibongiseni Dhlomo. (Photo: Joyrene Kramer)

Second in line is current Deputy Health Minister Dr Sibongiseni Dhlomo. He is also not on the ANC’s national list, but he is high up on the ANC’s KwaZulu-Natal regional list and thus also set to join the National Assembly. He is a former MEC of health for KwaZulu-Natal and former chair of Parliament’s portfolio committee for health. If Phaahla is not to return, Dhlomo would be the most natural replacement. 

After those first two candidates, things get much harder to predict. 

zimbabwean exemption permits

The Minister of Home Affairs, Aaron Motsoaledi. (Photo: Gallo Images / Sunday Times / Alon Skuy)

Former health ministers Dr Aaron Motsoaledi and Mmamoloko Kubayi are on the ANC’s national list and Dr Zweli Mkhize is on the ANC’s KwaZulu-Natal regional list. Given that Motsoaledi’s time at Home Affairs has been something of a disaster, it is not impossible that Ramaphosa might feel he can get more out of him back in the health portfolio where his record was somewhat better

A return of Mkhize to the health portfolio seems extremely unlikely given the grubby circumstances under which he left. Kubayi’s role for a few months as acting health minister was really just that of a caretaker, and a return is unlikely. 

Dr Zweli Mkhize during the Memorial Lecture by Dr Zweli Mkhize on O.R Tambo at Pietermaritzburg City Hall on November 19, 2022 in Pietermaritzburg, South Africa. (Photo by Darren Stewart/Gallo Images)

One interesting trend is that the ANC has largely chosen medical doctors as health ministers and deputy ministers – Phaahla, Dhlomo, Motsoaledi and Mkhize are all medical doctors. 

health call centre lapse

Eastern Cape MEC for Health Nomakhosazana Meth. (Photo: Hoseya Jubase)

Current Eastern Cape MEC for health Nomakhosazana Meth is high on the ANC’s national list, though the poor performance of the Eastern Cape Department of Health in recent years should mean her chances of getting the top health job are slim. 

In previous years, current Limpopo health MEC Dr Phophi Ramathuba was considered a possibility by some, but her name is only on the ANC’s candidates list for the Limpopo legislature and a few ill-judged incidents, such as a video in which she berated a pregnant woman, would make her a controversial choice. She’s also often been at loggerheads with unions in Limpopo. A lack of standing with healthcare workers may also hold back the prospects of one or two others with health backgrounds who did make it onto the ANC’s national list. 

Limpopo health MEC xenophobic, Civil Society Watch

Limpopo Health MEC Phophi Ramathuba. (Photo: Gallo Images / Sowetan / Sandile Ndlovu)

Candidates from other parties 

The DA remains South Africa’s official opposition. Should it become part of a ruling coalition or government of national unity, the current Western Cape health MEC would be the party’s most obvious candidate for the role of health minister. Nomafrench Mbombo is, however, only on the DA’s list for the Western Cape legislature and is thus likely to again be the province’s MEC for health.

Western Cape MEC for Health Nomafrench Mbombo. (Photo: Joyrene Kramer / Spotlight)

Jack Bloom, the party’s leading health MPL in Gauteng over the past two decades, would be a long shot for the post of health minister, as would Dr Karl le Roux, an award-winning rural doctor who has joined the party. Bloom is on the DA’s list for the provincial legislature and not on the lists for the National Assembly. It is therefore not entirely out of the question that he could become MEC for health in Gauteng.  

gauteng jobs campaign bloom

Jack Bloom, DA MPL in the Gauteng Provincial Legislature. (Photo: Gallo Images / Papi Morake)

The EFF received the fourth-most votes nationally, having been third in the previous national elections. In the previous Parliament it was represented on the portfolio committee for health by Dr Sophie Thembekwayo (not a medical doctor) and Naledi Chirwa. Chirwa is last on the EFF’s national candidates list and is thus very unlikely to return to the National Assembly. Thembekwayo is 36th on the EFF’s national candidates list. 

Economic Freedom Fighters MP Naledi Chirwa disrupts proceedings at the State of the Nation Address held at City Hall in Cape Town, 9 February 2023. (Photo: Shelley Christians)

It is also possible that other parties such as MK or the IFP could end up as part of a governing coalition or government of national unity and that candidates from these parties would also be in with an outside chance for the top health job. There will be many new, and to us unknown, faces in Parliament – no doubt Spotlight missed some people with solid health backgrounds in our analysis. 

As mentioned earlier, the President can appoint two ministers to his or her Cabinet from outside the National Assembly, so it is possible that someone with health management expertise could be roped in from outside the usual political circles. Though very long shots, outsiders such as Dr Fareed Abdullah – former CEO of the South African National Aids Council and an important player in the early days of HIV treatment – or Professor Glenda Gray – outgoing president of the South African Medical Research Council – might well, and arguably should, be considered. 

Dr Fareed Abdullah, who works at Steve Biko Hospital and was a director-general in the Western Cape health department for several years, has called for the 2021 local elections to be postponed. (Archive photo: Ashleigh Furlong)

Though it’d be a surprise if strong outsider candidates such as these two are interested in the job given how politically fraught the role is likely to be. That said, the right outsider candidate would likely be a hit in healthcare circles. 

Medical Research Council President and world-renowned infectious diseases scientist Prof Glenda Gray at The Gathering, 24 November 2022. (Photo: Felix Dlangamandla)

Ultimately, however the negotiations pan out, the ball remains in the ANC’s court when it comes to determining who will be our next minister of health. That means the decision is likely to remain subject to the ANC’s internal politics, with all the complexities that entails. 

Despite all the intriguing possibilities, chances are that it will be Phaahla or Dhlomo who get the nod – and in terms of South Africa’s healthcare trajectory, things will probably remain roughly as they are now. DM

This article was published by Spotlight – health journalism in the public interest. Sign up to the Spotlight newsletter.

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