NEWS & ANALYSIS

Aaron Motsoaledi: Not much of a bedside manner

William Saunderson-Meyer says the minister is in denial about the state of our public healthcare system

JAUNDICED EYE

Dr Aaron Motsoaledi seems to be a miserable bugger. Judging from his public persona, he is opinionated to the brink of arrogance, insufferably meddlesome and prescriptive, and entirely lacking in humour.

On the other hand, one supposedly can judge a man by the quality of his enemies. By that measure, Motsoaledi this week inadvertently got a ringing endorsement.

The Congress of SA Trade Unions has called for Motsoaledi’s head. Because of the collapse of healthcare, he should be fired at once, said the African National Congress’ alliance partner.

Motsoaledi was guilty of “denialism and scapegoating”, said Cosatu spokesperson Sizwe Pamla. “He is the only minister who has been allowed to stay in one position for close to a decade‚ without being reshuffled. He had ample time to set up a vision and implement it over the last nine years but he has spectacularly failed.” 

There’s no doubt that the healthcare system is in apparently terminal decline. No less of an authority than Health Ombudsman Professor Malegapuru Makgoba described it as “collapsing”, during an interview at the weekend, on the eve of his Office of Health Standards Compliance report being tabled in Parliament.

Out of 696 hospitals and clinics inspected by the OHSC, only five met the Department of Health’s requirements to achieve an 80% pass mark. Since the last report, the situation has deteriorated in Gauteng and Free State, while the other seven provinces remain virtually unchanged.

We can add to our list of Motsoaledi’s character failings that of denialism. The system is not collapsing, he earnestly assured the press conference hastily convened to rebut Makgoba’s explosive statements. It was just “very distressed”, the minister said.

Oh, and what about delusional, too? He told the media that the present parlous state of healthcare is no argument against the proposed National Health Insurance – a centralised structure costing billions and demanding high-levels of administrative and medical skills – but rather proof that the NHI is indeed sorely needed.

A dose of reality came from the SA Medical Association, which warned that the health service in SA’s economic engine room, Gauteng, is headed towards the same collapse as that which has struck Limpopo and Eastern Cape, and which in North West has led the health ministry to be placed under administration. 

The SA Committee of Medical Deans chipped in with a call for “drastic steps” to deal with a “limping and indeed failing” health system. The deans expressed also “grave concern about the future of academic medicine” and training. 

For the timid deans to speak out is significant but none of this is likely to deter Motsoaledi on the issue of the NHI, which is his go-to solution to all problems. To his mind, the “distressed” state of health is because the provincial governments are corrupt and dysfunctional. NHI centralisation will solve this. 

There are not enough qualified staff? To his mind that’s because the private health sector is siphoning them away. The NHI will solve this by knee-capping private medicine. 

Motsoaledi’s inflexibility regarding the NHI is subtly alluded to in the statement from the medical deans, who catalogued the disasters of Life Esidimeni and the collapse of oncology services, to conclude: “These [events] do not support an environment for the eventual realisation of a health system based on the concept of Universal Health Coverage.”

Malegapuru was blunter. “It’s a mess and requires very strong leadership, but that leadership requires a lot of consultation. There’s a lot of wisdom in the country and that should be used effectively by the national minister.”

But whatever Motsoaledi’s obvious failures, the greatest being this intellectual rigidity, it would be unfair not to also weigh his undoubted strengths. To start with, just compare his credentials to those of his most important predecessors, Nkosazana Dlamini-Zuma and Manto Tshabalala-Msimang, who together gave us 14 years of corruption, incompetence and Aids denialism.

Motsoaledi, in contrast, can take much of the credit for the successes achieved since in the fields of HIV/Aids, tuberculosis, as well as significantly improved maternal mortality and life expectancy statistics. He also had the guts to court political unpopularity within the ANC, by placing North West Health under administration.

The minister has incurred the wrath of the health unions not so much because he has been unable to resolve the healthcare crisis, but because he has dared criticise the barbaric actions of their members. He has called violent hospital strikers “murderers” and “hooligans” who “are not human anymore”. 

This is what really displeases Cosatu, which is accustomed to ANC ministers ignoring or making excuses for the sinister habit of the unions to use violence to achieve their goals. For example, the powerful Eskom unions this week said that they were prepared to “physically remove” the power utility’s newly appointed executives, because they were outraged at a 0% wage increase offer. The ANC said not a word in rebuke. 

Motsoaledi is certainly not the guy one would choose as the family GP. As Health Minister, however… Well, that’s could be a different matter, if he could only bring himself to be consultative and draw upon the wisdom that stands ready to help forstall total collapse.

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