A Covid-19 Action Plan designed for an Incapable State

16 July 2020

Today the DA will send to the Presidency a Covid-19 Action Plan that will ensure better healthcare treatment for all South Africans, as well as a far stronger prevention campaign to minimise the imminent strain on our healthcare system. This plan is critical if we are to mount an effective defence against the pandemic, because government’s alternative – indefinite lockdown – cannot be an option.

Our plan takes into account the many challenges unique to South Africa, the biggest of which is undoubtedly the incapability of a state hollowed out by cadre deployment and corruption – all under the guise of “empowerment” – to make critical decisions within a short timeframe and then implement these decisions efficiently across equally incapable provincial and local governments.

Drawing from the experiences of the Western Cape over the past three months, this plan focuses on the following ten areas for success:

Efficient decision-making structures

A coordinated testing programme

Contact tracing

Quarantine and Isolation facilities

Communications campaign

Evidence-based protocols and regulations for non-pharmaceutical interventions (NPIs)

Field hospitals

Oxygen

Staffing

Reprioritised funding

The state alone does not have the capacity to oversee or implement a Covid strategy. The decision-making process in a crisis needs to be swift and responsive, and it needs to draw on the expertise and the capacity of a wide range of players outside of government and the state. If we do not immediately change tack to expedite our Covid decision-making through parallel structures, and bring in far more outside experts as well as the private sector into this process, the result will be dire for millions of vulnerable South Africans.

All our other challenges such as funding, skills, supply chain, testing capacity, and the distribution of healthcare staff, can be overcome if we can circumvent where possible, and augment where necessary, our incapable state.

Outside of the Western Cape, where the early storm appears to have been weathered thanks to a concerted response effort that began the moment the country went into lockdown in March, the situation is critical. Across all eight of the other provinces there is no sign of the preparation that should have been taking place these past three months.

We are now fast heading into big Covid numbers, and it is already clear that the healthcare capacity in the vast majority of the country is nowhere near sufficient to respond to this surge. South Africa has 500,000 critical care hospital bed days available for the second half of this year. At the current trajectory we may need as many as 2.9 million critical care hospital bed days over this period. This means that five out of every six citizens requiring critical care may be turned away.

On the prevention side, the public sector is only conducting 13,000 tests per day, which is far short of its 36,000 target and well below the private sector’s rate of 37-38,000 tests per day. If public and private testing capacity is brought into one unified strategy, we could get on the offensive to suppress the epidemic. At the same time, the contact tracing programme should be provincialised and outsourced to the private sector, with clear service level agreements.

We estimate that an effective healthcare response replicating the Western Cape model would cost around R50-60 billion nationally for 2020/21. Compare this to the cost of lockdown which is R304 billion in lost tax revenue alone, quite apart from all the other costs to our economy.

Money should not be an obstacle to funding our emergency Covid19 healthcare response. The money is all there, it is just being spent on the wrong things because government is not willing to prioritise the people over its own vanity projects and failed SOEs.

Consider that South Africa will borrow R700 billion this year. Of this, the Department of Health will receive just R2.9 billion in new funding, while SAA will get R16.4 billion, the Land Bank R3 billion and e-tolls R2.5 billion. Even the unnecessary SANDF deployment to enforce the lockdown regulations and curfew cost almost twice the Health Department’s allocation.

This is not acceptable, and government will have to explain to South Africans why it places their lives so low on its list of priorities. Government will also have to explain what it was doing for more than three months while our country was in lockdown, as millions of people lost all they had. Because it certainly wasn’t building up our healthcare capacity.

But more urgently, government needs to show citizens how they will be kept safe and healthy in the face of a surge of Covid infections. The DA’s Action Plan will do just this by neutralising as far as possible the massive weaknesses of a corrupt and incapable state.

Issued by John Steenhuisen, Leader of the Democratic Alliance, 16 July 2020