Class of 2013
Treatment Action Campaign activists have scored the Health MECs in their provinces based on their engagement with civil society, their participation in the AIDS Councils and their approach to the most pressing challenges in their provinces. More specifically, the MECs were scored on their response to issues related to HIV. Health minster Dr Aaron Motsoaledi’s performance was also evaluated.
A: Doing a good job and must remain in 2014
B: Could have received an A score, but there are some challenges
C: Average performance with room for improvement
D: Not a good performance in 2013, could go either way
E: Heading for a fail
F: Fail and must be fired
Dr Aaron Motsoaledi: A
Start date: May 2009
Positives: Minister Motsoaledi is energetic and determined to solve the health system’s deep systemic problems. Reacting quickly to crises such as drug stock-outs and high death rates at hospitals, he has overseen the rapid expansion of South Africa’s HIV programme following the long period of government denialism.
Motsoaledi has a ten point-plan to improve healthcare services in South Africa. If he is successful, the plan will go a long way to solving issues such as high maternal and infant mortality rates. Motsoaledi faces significant challenges in getting the provinces to work harder at implementation and to be as committed as he is. He must get them to focus more on improving the lives of those relying on the public sector.
Negatives: Minister Motsoaledi has far too much on his plate. With only a small team of competent managers to support him, he risks becoming burnt out. He needs more help.
Civil society: From his first day in the post, the Minster has worked closely with members of civil society and is not scared to ask for advice. His mobile number is widely known.
SANAC: Motsoaledi has not yet managed to transform this institution. SANAC risks becoming an organisation unable to turn ideas into actions. It is still failing to drive the National Strategic Plan.
Report summary: Motsoaledi is one of the best Health Ministers South Africa has had. We hope he retains his post after the 2014 elections.[/box]
Hope Papo: D
Start date: July 2012
Positives: Papo is attempting to implement a turnaround strategy for Gauteng that includes the improvement of services at hospitals, the replacement of old equipment, and the employment of new CEOs at hospitals such as George Mukhari and Chris Hani Baragwanath.
Negatives: Papo’s response to drug stock-outs in Gauteng has been poor and he denies the seriousness of the problems.
Civil society: Papo does not engage well with members of civil society. He has only met once with TAC in 2012 when the organisation reported unacceptable hospital conditions. Papo has sent other officials to follow-up meetings.
Provincial AIDS Council: He attends some meetings but usually the Director General represents him.
Report summary: Very few people have managed to meet with Papo. He appears infrequently and usually only following pressure or protest. Communities are seldom informed in advance about his clinic visits. However, TAC branch members are vigilant. If they spot him, they use the opportunity to engage him.
Theuns Botha: C
Start date: April 2011
Positives: Theuns Botha facilitated the building of the Mitchells Plain and Khayelitsha Hospitals.
Negatives: He has failed to address the issue of poor service at Khayelitsha Hospital, despite being aware of problems at the facility after TAC sent a memorandum in September 2013. TAC has informed him that the service at the Mfuleni Clinic is also poor and that patients are forced to travel to Khayelitsha Hospital for treatment. We feel his response has not been satisfactory and that he does not address our concerns in his letter.
Civil society: Poor engagement.
Provincial AIDS Council: The MEC chairs the Provincial AIDS Council.
Meetings: Botha has met with TAC on a few occasions but has appeared defensive.
Report summary: Theuns Botha seems to respond poorly to concerns. His defensive reactions suggest that he believes TAC is politically aligned with the interests of the ANC. He needs to demonstrate more interest in engaging with people and a commitment to overcoming the Western Cape’s health service challenges..
Sicelo Gqobana: F
Start date: November 2010
Negatives: Sicelo Gqobana is a teacher without a medical background and this could explains why he appears to be out of his depth in this portfolio. He has failed to tackle the corruption in the health system and offers neither clear direction nor leadership. Instead, he is accused of removing officials who have attempted to address this issue.
Gqobana failed to intervene in the strike at the Mthatha drug depot or to address the shocking state of the Village Clinic in Lusikisiki. The national Minister of Health intervened instead.
On his watch, many healthcare workers in rural areas have continued to live in unacceptable conditions, without electricity, transport or running water. People are deployed to positions for which they are not qualified, and fraudulent payments to non-existent ‘ghost workers’ are continuing. Gqobana refuses to respond to communication from residents or members of civil society. Many hospital and clinic buildings are falling apart.
Civil society: His engagement is extremely poor. TAC has been trying to meet with him since 2012. Gqobana uses public platforms to attack those who hold him to account.
Provincial AIDS Council: Gqobana has not attended Council meetings.
Report summary: Gqobana refuses to acknowledge the scale of the crisis in the Eastern Cape. We recommend that he be removed from his post..
Dr Benny Malakoane: E
Start date: February 2013
Positives: Malakoane has integrated the provincial TB and HIV programmes.
Since he came to office, Malakoane spends too much of his time in meetings with departmental heads and managers. When the Premier of the Free State showed no interest in chairing the Provincial AIDS Council, Malakoane took on this responsibility. The province committed itself to a target of getting 40,000 people on HIV by the end of 2014. Its total already stands at 140,000.
Negatives: He is refusing to make funds available for a civil society forum despite a commitment from the previous MEC. He has also failed to address the problem of drug stock-outs of ARVs, TB drugs and medications for chronic conditions. Budget constraints mean that departmental posts are frozen, emergency services have collapsed, and that health managers are unable to travel because they have no fuel for their vehicles.
Malakoane has failed to make agreed funds available for HIV Counselling and Testing campaigns. A TAC memorandum submitted to him on the TAC Day of Action received no response. Two weeks after his appointment, the MEC faced charges of corruption in connection with his work as a municipal manager.
Civil society engagement: Malakoane’s level of engagement is declining. He has been unreachable for the past few weeks.
Provincial AIDS Council: He chairs the Council but has not created an environment in which stakeholders feels they can participate. He has met only once with TAC during a Provincial AIDS Council meeting.
Report summary: He is not performing well and the future looks bleak.
Dr Sibongiseni Dhlomo: C
Start date: April 2009
Positives: Access to antiretroviral therapy (ART) in the province is good. Dhlomo has a hands-on approach to issues such as preventing fraudulent or unsafe medical practices. He is not afraid of asking for public assistance when trying to resolve difficult problems such as the high rate of maternal mortality in the province.
Negatives: Is not prepared to tackle the Tara KLamp issue (www.tac.org.za). He has failed to establish consultative civil forums in accordance with the National Health Act. Dhlomo reportedly also behaved inappropriately by allegedly using an emergency helicopter to attend a private wedding. He has never explained himself and has never been held to account.
Provincial AIDS Council: He is active in the Council and has played an important role in making it a critical platform to tackle HIV issues in the province. KwaZulu-Natal is held up as a best practice model when it comes to AIDS Councils.
Report summary: A person who can be stubborn, but who has the potential to become an excellent MEC.
Dipuo Letsatsi-Duba: D
Start date: July 2013
Report summary: Recently appointed, Letsatsi-Duba has made substantial promises but not yet fulfilled them.
Norman Mabasa: B
Time in office: February 2012–July 2013
Positives: Gaining access to Mabasa was easy.
Negatives: He was politically naïve, leading to his removal.
Civil society: He was responsive to members of civil society and met regularly with TAC.
Provincial AIDS Council: Norman Mabasa was involved in Provincial AIDS Council meetings and understood what the structure needed to achieve.
Report summary: An MEC who responded to issues raised by TAC throughout his term. We were sorry to see him go.
Candith Mashego-Dlamini: D
Start date: February 2013
Positives: Thirty park homes have been placed at clinic sites and 180 ambulances were purchased in May. Eye care programmes have started at several schools.
Negatives: Has failed to attract doctors to the province or fast-track urgently needed facility renovations.
Civil society: Since taking office Mashego-Dlamini has met with members of civil society. She met with TAC in August to engage on issues related to Gert Sibande, a pilot NHI district site, and will meet with the organisation every three months.
Provincial AIDS Council: Mashego-Dlamini participates in the meetings, but has not been able to do so fully because the Provincial AIDS Council was established only very recently.
Report summary: This is Mashego-Dlamini’s second period as the provincial health MEC. Previously she did not want to meet with members of civil society. Her performance is improving.
Dr Magome Masike: E
Start date: May 2009
Positives: Dr Magome Masike visits hospitals and clinics regularly and supports the use of mobile clinics for visits to rural areas.
Negatives: Masike has not focused on staffing or building more clinics. Complaints about negligence and unqualified staff have been shared with him, but without any action. NGOs that are providing community education lack training. Regular stock-outs of ARVs and chronic medication are impacting patients at rural clinics.
Civil society: Thus far, Masike’s only engagement with members of civil society has been via attendance at World AIDS Day event.
Provincial AIDS Council: The MEC is a member and attends, but is not an active participant.
Report summary: The MEC has failed to resolve the significant service delivery problems in the province, including lack of access to treatment.
Mxolisi Sokatsha: C
Start date: May 2009
Positives: The Provincial Aids Council is now functional. Sokatsha permitted civil society members to co-chair the council in his absence. New clinics have been built and funds have been made available for a People with AIDS (PWA) summit.
Negatives: Many rural areas still do not have clinics. Communities depend on mobile clinic services but these are unreliable. Sokatsha needs to provide more bursaries for students who want to study health.
Civil society: TAC does not have a branch in the province but the MEC works closely with the National Association of People living with HIV/AIDS (NAPWA).
Provincial AIDS Council: Sokatsha is an active member of the Provincial AIDS Council and activists are able to contact him easily.
Report summary: Sokatsha is flexible, supportive and approachable. Activists regard him as being only an SMS away.