“Mr Fix It” is how North West Health MEC Madoda Sambatha hopes to become known, but there’s a long way to go before he can claim the moniker and he knows it.
Problems in the province have piled up spectacularly in recent years. Just over a year ago the North West was brought to its knees with hospital strikes and violent service delivery riots. The strikes took place against the backdrop of a complex political tug-of-war between trade unions and factions in the ANC – all while various provincial government departments, including health, were under national administration because of severe inefficiencies and failures.
Sambatha (44) says it’s time for new rules of engagement with “a highly unionised sector”. He acknowledges that “a wedge has come between workers and departmental managers”.
“We need to have a different work culture and a different approach where it’s not about meeting every demand the workers want, but we don’t run away from engaging either. We must have peaceful co-existence whether we agree or disagree; we can’t wish each other away.”
But uncertainty remains
Despite strikes in the public healthcare sector in recent years, there is still not a definitive national ruling or guidelines on a minimum service level agreement when strikes happen.
“I don’t think that the two constitutional rights of the right to access to health and the right to strike should be pitted against each other. But we can’t allow people to block patients from getting into hospitals for medical treatment,” he says.
Sambatha was the chair of the portfolio committee on health and social development in the North West before he was axed by the controversial former North West premier Supra Mahumapelo in 2017. This was ostensibly over a questionable sign-off on a land deal – although there is speculation that he was a victim of internal ANC politics in the run-up to the party’s hotly contested December 2017 congress.
He is also the South African Communist Party’s regional secretary in the North West and a former mineworker who rose through the ranks of the National Union of Mineworkers in the mid-1990s.
Sambatha says that various longstanding workers’ grievances in the province’s healthcare sector must be resolved. Key among these, he says, is the issue of outstanding performance assessments and unpaid performance bonus payments for the last three years.
“It has cost us about R5-million to catch up until 2018 and to make these pay-outs, but this is a step forward in compliance from the government’s side. It means we move closer to closing this grievance. It creates stability and responsibility for the employee and the employer.”
The MEC says the department intends in-sourcing security services as per national guidelines. This will be phased in over the next few years because in-sourcing doubles the bill for security.
“We will also be doing evaluations on all out-sourced services to see where we can cut costs. We have some private companies that were providing services to us that our own HR and corporate services should be doing,” he says.
The Mediosa and Buthelezi EMS scandals
Two high-profile scandals in the province’s health department in recent years relate to contracts with the Gupta-linked Mediosa, which was contracted to provide the province with mobile clinics, and Buthelezi EMS, a private ambulance service. Spotlight revealed in April 2017 that the province had misused funds earmarked for HIV to pay Buthelezi EMS and reported on allegations that Buthelezi EMS had dramatically overcharged the department. Contracts with Buthelezi EMS has since become the subject of National Treasury, Hawks, and most recently Special Investigating Unit investigations.
City Press reported in August on the Hawks’ arrest of former North West finance MEC Wendy Nelson on charges of fraud linked to her involvement in appointing head of department of health Thabo Lekalakala, who signed off the contract with Mediosa. Lekalakala was suspended but went to court and successfully contested his suspension. He has, however, subsequently been arrested on charges of fraud.
Sambatha says even though the dubious Mediosa contracts have been terminated, investigations are under way. Mediosa has been liquidated, and Sambatha intends pursuing avenues to recoup monies lost in these deals, so “we are sure we only paid for services rendered”.
The province has a dire shortage of ambulances. It needs 260 ambulances and only has 100. Sambatha has budgeted for 40 ambulances to be purchased every year; he also needs more competitive salaries to retain trained intermediate life support teams and a new dispatch system for provincial-level operations.
“We have to pay paramedics to stay. Every ambulance needs to have working communications systems with the control centre, a panic button and a tracker to stop attacks on paramedics and to stop the element of abuse,” he says.
Suspected corrupt officials suspended
Emerging from the Buthelezi and Mediosa scandals has made Sambatha take a dim view of how tenders and some procurement contracts have become “properly regulated corruption schemes”.
He says it has been a case of having to “make yourself known” to politicians and officials if you want to land a tender or a contract.
Sambatha says he has recently suspended senior officials who have been suspected of nepotism and offering jobs for sexual favours.
He also challenges government’s own inefficiencies that, according to him, have made procedure a red tape nightmare.
“Sometimes there is no logic. When you have to buy something you must source three quotations from preferred providers and you are told to take the cheapest but sometimes if you just go to retail you’ll get it even cheaper. Compliance can be wastage, it’s ticking a box while we are told that the South African economy needs to improve money circulation for enhanced economic participation,” he says.
He feels the same way about transversal tenders. He says some tenders that are prescribed nationally don’t stimulate local growth. As an example, he points to a hospital oxygen supplier who, in its tender, offered to train about 44 people. Sambatha considered this to be a win for skills training, job creation and localised procurement but couldn’t sign off on the tender because of transversal tender agreements.
Other changes he’s implementing include the ordering and delivery system for medical supplies. He says individual hospitals will be ordering supplies directly while clinics will continue to order through the medical depot to better manage stock levels. The MEC also wants revised delivery schedules to stop time and fuel wastage.
According to Sambatha, the moratorium on frozen posts has finally been lifted, allowing the department to advertise 3,000 posts for professional, clinical and support staff. He says they are at the halfway mark of filling these posts.
More public-private partnerships
The province also intends leaning more on public-private partnerships. Sambatha says the imbalance of overcrowded public and under-utilised private hospitals needs to be levelled out.
“I want to change the conditions of licensing of private facilities so that we can offload patients there and they will charge us at government rates to treat these patients.
He says these partnerships offers an alternative to simply building more facilities that will ultimately not have staff to run them properly.
The MEC will also focus on a campaign of health, diet and exercise for the province and believes people should work to stay well.
Maybe more difficult than getting people to exercise and change to healthier diets, however, will be to undo the culture of corruption distrust that seems to have become pervasive in the province.
He’s determined to rebuild that public trust, which is why he’s making surprise appearances at clinics and hospitals throughout the province.
“Every week I take three visits and arrive unannounced. Then I introduce myself and ask to see the facility,” he says.
“I knew the level of rot before I came to this office so I can’t say that things are okay now because I am the MEC,” says Sambatha. “I want to be a Mr Fix-It, I’m not running away.”