Opinionista Onkgopotse JJ Tabane 6 December 2012

Dear Minister… let’s talk frankly

The Department of Health’s approach to HIV/Aids has resulted in life expectancy rising 10%. The models for these successful initiatives must now be applied to other areas of public health, including infrastructure development and the ambitious National Health Insurance plan. 

Dear Minister Aaron Motswaledi, 

A few years ago, when you assumed your position, I wrote you a rather unkind letter, sceptical about your apparently gung-ho attitude to changing South Africa’s approach to the HIV/Aids scourge. 

It was my view that you were jumping on to the bandwagon of merely vilifying what had gone before – a case of a new broom sweeping clean. I must now eat humble pie. 

You have outdone yourself and have provided leadership on a crucial issue facing our society. You are going about your job with a serenity and enthusiasm not seen from a health minister since 1994 and your effort has seen life expectancy rise by 10% – no mean feat. 

There has been tremendous progress. From obfuscation on the issue of treatment, to South Africa boasting the biggest ARV programme in the world. From prevarication on the issue of nevirapine for innocent kids caught in the HIV transmission crossfire, to having a hospice in Johannesburg close its doors because no children are now dying of HIV. 

Dear Minister, take a bow. Under your leadership the country has made strides in combating the biggest scourge that this country has had to deal with since it was liberated. Today we are no longer talking about awareness of HIV; we are talking about a concrete strategy where people are aware that they need to know their status. When leaders like you lead by example and get tested, the citizens will take note. It’s a bonus that you got the President and his Cabinet to know their status as part of the overall arsenal against the disease. May you go from strength to strength as we once again mark World Aids Day.  

The issue of combating HIV in schools is yet another one of your bold initiatives. I am not sure, though, about the distribution of condoms at schools. This can only be sensible if it is accompanied by a thorough sexual education programme, otherwise it can exacerbate what is already a problem out of hand. I am not convinced that this is the most exciting thing that could have been done given the lethargy of our education system at present. Our own teachers need sexual education to start with. How will we get these condoms distributed to schools if we can’t get textbooks there on time? I know that one of your big headaches is the huge pregnancy rate at schools. This must have prompted you to take this rather radical decision. I have, however, not yet heard of a serious programme to deal with teachers, who are themselves culprits who impregnate school children.  I am sceptical that simply distributing condoms is either timely or strategic. I will however withhold judgement until the effectiveness of this strategy is borne out by statistics.    

 Of course, like everything else in politics, we have to move on to other more challenging things to make our people’s lives better. The National Health Insurance plan is what seems to fill your plate these days. Frankly, many people are nervous about this policy and its pending implementation. You may dismiss some of their concerns as “not so progressive” but let us journey a little bit on this matter. Our current health system where medicines are dumped on roadsides and patients are sent home to go cook for themselves or have to bring linen to the hospital does not inspire much confidence. The prospect of having to seek medical treatment at a public hospital does not have too many people jumping for joy. I am glad that you have offered that you and your family will make use of public hospitals to make the point that these facilities are still viable as health centres. If your gesture is to be taken seriously, I suggest you extend that commitment to the whole Cabinet and all civil servants. Otherwise it will be seen as a political gimmick.  The building of five new hospitals must also be commended as a step in the right direction to fix access to healthcare for the majority of our people. 

The public, you will agree with me minister, has every right to be nervous if the biggest province, Gauteng, had to have its health department placed under administration. Doctors are fed up with their working conditions and infrastructure is poorly maintained, with lifts not working in theatres – to highlight but one or two horror stories. I recently visited a patient at the Dr Yusuf Dadoo Hospital in Krugersdorp. The place is dilapidated. Cracks in the floors and the walls suggest that the last time it was refurbished was probably in the 1980s. 

Chris Hani Baragwanath Hospital in Soweto has been without certain medications for 18 months. How do you explain the logic behind the pharmacy of one of the largest medical institutions, which boasts the best medical practitioners, not having a supply of medication. 

Mahatma Gandhi Memorial Hospital in Phoenix, north of Durban, opened its doors for the first time in 1997. It has a large maternity section where about 10% of the babies born in South Africa every year take their first breaths. Despite being modern and sophisticated by the standards of many South African public hospitals, Mahatma Ghandi Memorial has gained notoriety recently for the deaths of newborn infants, from causes that should be easily preventable.

But there is something extraordinary in the way that the staff have kept these places spotless nevertheless. This is a sign that you need to do everything in your power to make sure that never again should doctors have to go into the streets because they are being paid peanuts.  These are committed servants of the people being let down day in and day out by a dysfunctional bureaucracy. 

The solutions in this regard are long term and not simply stop-gap measures to put out the fires as you so effectively did when the sector went on strike a few years ago.        

Last week a group of youngsters left for Cuba to be trained as doctors in order to boost the ranks of our public service doctors. Well done on your determination and vision to fix this lack of capacity in our hospitals and clinics, especially in the rural areas where young doctors are not keen to be posted.

The National Health Insurance plan is a progressive policy that will require strict attention to detail in implementation. As you approach Mangaung to get final endorsement of this policy from congress, I hope you have a “Marshal Plan” for the implementation of this radical policy. It is important that we do not attempt to fix what is not broken in pursuing parity between the public and private health industries. Citizens will be watching these developments with keen interest. 

Let us return to the good news. For a change as we marked World Aids Day, we did so with pride, knowing that your leadership on this crucial issue has borne fruit. We must extend this leadership to make sure the country is fully behind the National Health Insurance plan; it will only succeed if all of us play our part. 

Dear Minister, you are simply one of the success stories of this government and most probably one of President Zuma’s excellent appointments. I have no doubt that your accessibility and the enthusiasm you bring to the Department of Health’s commitment to “a long and healthy life for all South Africans” will leave a lasting legacy of a better life for our people. You are a light that shines into our future proving wrong those sceptics who have written off government’s health management. 

Yours frankly,

Onkgopotse JJ Tabane DM

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