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Brick by brick: Rebuilding Gauteng Health with consistent activism, a progressive reform agenda and leadership


David Maimela is chief of staff in the office of the MEC for health in Gauteng. He writes in his personal capacity. This article is the first in a series that reflects on the strategic questions that face the health system in the province.

To entice the millennial healthcare professional and retain her skills in the public service for longer, requires creativity and innovation. Gauteng’s health programme, guided by the right spirit and ideas, is well placed to succeed at this.

An old belief system dating back decades, if not centuries, has come to characterise a generation that is somewhat stillborn in the South African political space. It is said that the bride who grew up eating from the pots is unintentionally cursing her wedding day, because on the day of the wedding it shall rain and thus spoil the celebration. 

If one looks at the state of and prospects for the Gauteng department of health, a multiplicity of storylines emerges: some good, some bad and some undecided. 

Here you have the biggest regional health system in the Southern African Development Community (SADC), with 22 million visits to its facilities in a population of about 15 million people. 

The system has 36 hospitals (four of which are academic and service the whole country and beyond) and more than 350 clinics; 34 of which are 24-hour clinics, and all of which are serviced by about 75,000 healthcare workers.  

The question arises at a political and policy level: What is the significance of health in general, and Gauteng Health in particular, in the quest to improve the quality of life of our people? 

In order to answer this question, we shall look at some interesting data and dynamics to which the health programme must respond. 

Back in 2016 – the year of the dramatic local government elections – the Mapungubwe Institute for Strategic Reflection (MISTRA) conducted a study into the political attitudes of millennials in South Africa. 

It was but one of the countries sampled across six continents, with more than 20,000 young people interviewed across the world. Millennials are generally defined as people between the ages of 15 and 35, born between 1980 and 2000. The sample was representative of race, gender, class, age and geography. 

The study discovered, among other things, that of the 17 important things of interest to millennials, being happy ranked first, being in good health second and being successful third. 

“Taking an interest in politics” ranked last, at number 17. 

Millennials were not entirely disinterested in politics or public life. Instead, they had conditions for engagement: about 39% said they preferred a “well-known politician who agreed with their views”, and 35% said they would be more interested in politics even if an “unknown politician of their age comes across very well”. 

In terms of the “ideal” candidate or politician to lead, most of the millennials preferred leaders between the age of 25 and 35, with a slight bias for a female leader. 

Regarding the issues that matter most: out of 14, they ranked healthcare the second most important issue after jobs. 

Healthcare is not only an important basic need, but a fundamental human right as guaranteed by our Constitution. Any political system and leadership that ignores this fact is likely to suffer consequential political setbacks.

This brings me to work being done by the ANC-led government on health. 

Its health programme is precisely the one best suited to reach out to and inspire millennials so that they remain optimistic about politics and their future, especially after the dramatic turn of electoral events in 2016 and 2019. 

What is really required is to understand, organically and scientifically, the demographic shifts in society and their implications for politics, especially on issues like aspiration, personal well-being and security, optimism about the future, messaging and imagery. 

Most millennials do not want dependency on the state for survival, social mobility, identity and dignity. They understand the idea of freedom to mean that they must be independent and impactful in all endeavours of life. 

Despite the disruption caused by Covid-19 and related allegations of corruption, the health programme in Gauteng is beginning to capture the imagination of millennials, both inside the department and the community. 

It is aided by a leadership that believes in a progressive reform agenda of Gauteng Health. 

It is important that we acknowledge the reality that the current cohort of nurses and doctors are largely millennials who have no first-hand experience of our brutal past, owing to the fact that they were born in the last decade of apartheid. 

In order to appeal to millennials politically, you have to sell the idea of the future – the idea of hope and prosperity. 

As 2020 comes to an end, and as we approach the last quarter of the first year of the sixth administration, it is becoming clearer once more that building institutions takes time and reforming them is not easy, but neither is it an insurmountable task. 

Some reform initiatives are beginning to show results and some have just begun gaining momentum. The undertaking is straightforward: accelerate the implementation of the health programme and reform as you rebuild. 

The undertaking seeks to improve things such as staff morale, infrastructure, leadership, governance and a range of rewards and recognition of our frontline healthcare workers. 

Rebuilding Gauteng Health is not enough. A reform agenda is necessary. It will take a bit of time but it will be done. For example, the idea of health facilities of the future accounts for the reform efforts. It takes into account the changing needs of millennials and the changing nature of work. 

The idea that you can have indoor sport facilities, staff gyms, convenient shops, coffee stations and other amenities for workers at health facilities is one of the key things in the pipeline to uplift staff morale, modernise and revamp new and old infrastructure and workspaces in a manner that shows government cares about the well-being of its 21st-century workers. 

Of course, this type of work and investment requires resources. To this end, we have begun to mobilise the private sector through various forms of smart partnerships, including leveraging corporate social responsibility. 

Lately, a considerable number of companies have become interested not only in the traditional profit bottom line, but also in contributing to social progress, stability and cohesion. It is for this reason that the innovative employee value proposition programme of Gauteng Health is largely supported through donor funding. 

To entice the millennial healthcare professional and retain her skill in the public service for much longer, requires creativity and innovation. The introduction of the Mpilo app and the revival of the health information system (HIS) project are exciting reforms that seek to modernise our health system in a manner that keeps our communities engaged and their satisfaction levels rising. 

Besides reporting bad service instantly, the Mpilo app makes it possible for people to call an ambulance at the press of a button and see it move from the ambulance station to where the patient is. 

The HIS project is aimed at revolutionising patient files in line with South Africa’s National Health Digital Strategy 2019-2024. This will certainly improve waiting times, accuracy and safety of patient data, planning and monitoring, among other things.

As indicated above, due to the volumes that Gauteng Health deals with annually, the services we offer have to respond to the changing demographic profile of the province and cater for the various ways in which our population prefers to receive and experience healthcare. 

Millennials and their attitudes are a great pointer to the future that we must choose. We must see their changing needs and demands not as a burden, but a motivation to do things differently, smarter and faster. This requires that we have an agile and visionary leadership that appeals to the attitudes of millennials and the broader Gauteng community. 

It has long been established that Gauteng is a complex social, economic and political space. Logically, it follows that the leadership and ideas required to lead this region should be dynamic, adaptive, strategic and grounded.

Again, despite the headlines of the day, Gauteng Health is a great institution and holds great promise for our country. 

Despite the challenges, legacy issues and lately the Covid-19 pandemic, there is no doubt that the health programme in Gauteng will succeed. It is guided by the right spirit and ideas. With consistent activism, a progressive reform agenda and leadership, it can be done.

As 2020 comes to an end, and as we approach the last quarter of the first year of the sixth administration, it is becoming clearer once more that building institutions takes time and reforming them is not easy, but neither is it an insurmountable task. 

To return to the metaphor of a cursed wedding day: Let us hope that as we continue to rebuild Gauteng Health, we do so in a manner that avoids spoiling an imminent celebration of a better healthcare system with better outcomes. 

Alternatively, the rain could be a sign of blessing. DM/MC


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