As always with public sector strikes, there is a rash of confected sentiment against the strikers. This time has been no exception. The thousands of peaceful strikers around the country are not good news material. Boring.

But a striker attacking an ambulance with a panga – now that’s more like it. And some people whose deaths can be attributed to the strike – even better. The culmination on this occasion was the call by Adriaan Basson, News24 editor, for Nehawu leaders to be charged with murder.

So maybe it’s time for a bit of perspective.

Firstly, hugely regrettable as it may be, South Africa is an extremely violent country. We all know that. Violent deaths occur every day – many times every day. Mass events are very unlikely to be any more peaceful than the  society in which they occur. So, it is very far from surprising that there is violence during strikes.

But of course we should do whatever is possible to avoid violence and death. Which is why it would be reasonable to suppose that when Nehawu approached the government to negotiate a Minimum Service Level agreement under Essential Services legislation, they would be met with a positive response. This is, after all, how it works in most of the world.

Unfortunately not in this case.

Since the time of Aaron Motsoaledi’s tenure as minister of health, the government’s response has been clear – we will not negotiate such an agreement with you because that would be to collude with you in taking strike action. By that logic, the Constitution’s recognition of the right to strike is also collusion.

And this nonsensical logic does put into perspective the actions of the current Minister of Health Joe Phaahla in managing to find four patients who are alleged to have died as a result of the strike. These tragic deaths may well have been preventable – and an agreement on minimum service levels with the unions would be a good place to start.

Death by Budget

Which brings us on to the second point. Joe Phaahla was so alert to the finding of potential casualties of the strike. But if he was really deeply concerned about unnecessary deaths, he would not have had to look further than the Budget of the government of which he is a part. His colleague, Enoch Godongwana, slashed the health budget in the misbegotten interests of a “primary budget surplus”.

Godongwana’s Budget cut the budget for the health wage bill by R15-billion in 2023/24 (about 5.2% in real terms). South Africa already has about 40,000 vacancies in the public health sector. Hospitals and clinics are already grossly understaffed and the staff who are there are horribly overworked.

Yet these cuts cannot be implemented without further reducing the number of workers in the sector. The estimate for the Western Cape alone is that 1,600 health worker posts will not be filled when those who are currently filling them leave.

Does Phaahla really think that these budget cuts can take place without people dying?

In fact, if he wanted to, he could find the names of people who had died from the neglect caused by those cuts. So could Adriaan Basson. Why doesn’t he issue a call to put Enoch Godongwana (and his boss, while we are at it) in the dock for murder?

Perhaps they should be asked to answer the question posed last year by Dr Tim de Maayer in his desperate open letter to alert the public to the collapse of the Rahima Moosa Mother and Child Hospital: “Would you trust the overburdened and burnt-out healthcare staff to look after your little one in their hour of greatest need?”

But of course, as Cabinet ministers, they wouldn’t have to. Private healthcare is readily available. Or the recent report of the health ombud on the same Rahima Moosa public hospital which highlighted shortage of nursing staff as one of the problems.

But of course they don’t really want to find suffering people. They want to bash strikers.

And let us not forget that these strikers are workers who have come off a year of zero increase, thanks to the extraordinary judgment of the Constitutional Court which allowed the government to renege on a signed agreement with the unions, and are now being “offered” a 3% increase in an environment of 7% inflation. A wage cut two years in a row. A loss of nearly 10% of their buying power.

Bloated public sector?

“But what about the bloated public sector?” comes the chorus. The number of nurses and doctors is not bloated. Queues at clinics are not reducing. Pressure on beds in hospitals is not easing. The health service has staggered on with a bit of assistance from the additional personnel allocated during the pandemic. Now they want to take those additional staff away again – because of the budget cuts.

We are not talking about unnecessary posts. We are talking about key frontline workers – a matter of life and death.

What about the debt?

“But we can’t afford it; we have to reduce the debt” – that’s the next response from those avid supporters of the national Budget, which was generally warmly received by business and the mainstream media.

Yet, other ways of reducing the debt have been proposed for years now, without any coherent response from government:

• Instead of going to the capital markets to borrow, at exorbitant and unpredictable costs – unpredictable because of fluctuating interest rates and the value of the rand – use your own money. R2.3-trillion in the Government Employees Pension Fund (GEPF). Pensions of public sector workers can be guaranteed by a fraction of that amount. It could cover the entirety of Eskom’s debt, for example, without the slightest risk to pensions. But instead, the government continues, every year, to pour more billions of public money into that already bloated fund and then to borrow it back from commercial lenders. And to make matters worse, one of the commercial lenders is the GEPF itself! In March 2022, 14% of the Treasury’s domestic debt or R526-billion was owed to the GEPF at market interest rates.
• Instead of cutting expenditure on an already crippled public service, increase revenues. South Africa is the most unequal country in the world, and yet our tax regime sits somewhere around the global average. There have been plenty of convincing arguments made for the institution of a wealth tax, a reversal in the tax breaks for high earners, and a financial transaction tax. If any new taxes are beyond the pale for our timid government, then how about simply adequately enforcing those that already exist? SARS has long bemoaned the lack of adequate funding, and our persistent illicit capital flight (in the hundreds of billions of rand) points to the need for a comprehensive Anti Tax-Avoidance Act.

Privatisation by the back door

There is growing evidence that the degradation of the public health service is not innocent of ideology either. Just as the decline in the public education service has promoted the growth of the private schooling sector, and the inefficacy of the police services feeds the private security industry, and the inability of the state to provide electricity requires all of us to find our own, private solutions, so the decline in the public health sector is starting to feed the private health sector.

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Look at the recent announcement of the Gauteng finance MEC – that they will be outsourcing some radiation oncology services to the private sector. Lack of equipment and a gross shortage of staff are cited as reasons. And this is already happening in the Eastern, Western and Northern Cape.

A growing number of people argue that privatisation is the way to go. They maintain that we can’t continue to fund a public sector which is corrupt and incapable of delivering. But this is both shortsighted and just plain wrong.

The key problem of the public sector lies not in the public sector itself, but in its relations with the private sector. It is the contract with an ANC-aligned company to fix the roads when that company has no expertise to do so; the contracts to build Kusile and Medupi to the benefit of Chancellor House; the contract with the public sector to build a stadium which never gets built.

We know the story.

The lesson we should be learning from this is that we must go back to having a real public sector – municipalities with roads departments, Eskom with serious maintenance capacity, logistic offices at public hospitals that buy their equipment directly from wholesalers and retailers and not from middlemen  – so that we don’t need contracts with dodgy companies to deliver services which simply don’t get delivered. The public sector must deliver itself.

So what do we do?

First, we pay our public sector workers properly, making sure that they get increases that at least cover inflation. How do we expect proper service delivery from an underpaid, demoralised workforce?

Second, we fill all public sector posts. Overfull classrooms and understaffed hospitals and clinics are not a recipe for effective public services.

Third, we reverse the direction of the last 30 years and rebuild the public sector into a service that can deliver to the people of South Africa.

And fourth, we use to the greatest effect our own resources to fund our borrowing rather than feeding the coffers of international, commercial lenders.

That at least would be a start in reversing the horrific decline we are currently witnessing. DM