Blow to Health Professions Council as new registrar faces serious charges

Blow to Health Professions Council as new registrar faces serious chargesIn the eye of the storm. Dr David Motau, former HOD of the Free State Department of Health who is now registrar of the HPCSA. PHOTO: Refilwe Mekoa/Spotlight
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UPDATE: On 5 August 2021, the day after this story was originally published, Acting Minister of Health Mmamoloko Kubayi placed HPCSA Registrar Dr David Motau on precautionary suspension.

The already battered image of the Health Professions Council of South Africa (HPCSA) has taken another blow with its recently appointed registrar Dr David Motau this week appearing in court in connection with allegedly corrupt payments amounting to R8.7 million of public funds.

The charges relate to Free State Department of Health tenders and contracts signed off between January 2011 and December 2015. Motau joined the Free State Department of Health as head of department in 2013. This year, he resigned and took up the post as registrar of the HPCSA towards the end of June.

On Monday (2 August), Motau, together with 10 others, appeared in the Bloemfontein Magistrate’s Court on a total of 304 counts ranging from contravention of the Public Finance Management Act, forgery, uttering, fraud, corruption, and money laundering. Motau himself is charged on 45 counts.

Motau himself is charged on 45 counts.

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Motau spoke to Spotlight about his plans to reform the HPCSA before he was ordered to appear in court. On Tuesday he responded to follow-up questions after being charged.

He maintained that he inherited many of the problems relating to the contracts and tenders that the state has alleged are corrupt deals by the time he joined the department. He said he was “not aware of the alleged commission of such offences”.

Motau also said he is “solely being charged for being in contravention of sections in the Public Finance Management Act (PFMA)” and intends pleading not guilty when he and his co-accused appear in court again on 22 September.

Spokesperson for the Directorate of Public Prosecutions (DPP) in the Free State, Phaladi Shuping, explained that Motau faces 44 counts of contravention of the PFMA and one count of “accepting gratification”.

Motau said he has written to the president of the HPCSA since being charged but said charges against him “should not follow him to his new role”.

HPCSA spokesperson Christopher Tsatsawane did not respond to questions about any action the Council intends to take in light of Motau’s court case or Motau’s future at the HPCSA.

The other accused in the case are Motsumi Polori and Kenosi Legobate, who are still employees of the provincial health department as well as retired employees Mietjies Johns, John Chakane, Maria Mabitle, and Lebohang Beqeze.  Tsietsi Polori, Thabo Moeti, Mavuso Kwababa, Simon Njonga and Charity Moloi who were directors of the companies implicated make up the remainder of those charged. The companies implicated are Tsa Rona Consultancy, Azrago, Land Breeze Trading, Amakholwa Consultancy Training, and Zen Communications.

According to a DPP statement, it is alleged “that between January 2011 and December 2015 the officials facilitated and approved payments of claims for services that were not rendered by these companies. The companies were used by department officials as vehicles to commit the offences because they never rendered any service to the department”.

Motau and the other accused were released on bail of amounts ranging from R2 000 to R5 000.

History of controversy

The Free State Department of Health was considered one of the country’s worst-performing for years. It was placed under administration by the provincial treasury in years largely overlapping with Motau’s time in the key position. The department previously told Spotlight that it was under administration from 2014 to 2018 – although it was taken out of administration for five days in February 2017, a period in which Motau signed off questionable price increases for a private ambulance company contracted by the department.

The controversial Buthelezi EMS ambulance base in Bloemfontein earlier. The SIU is now investigating the ambulance contract. PHOTO: Spotlight

Issues that Spotlight has reported on from the province include controversial contracts with a private ambulance company (currently being investigated by the Special Investigating Unit), the purchase of inferior or inappropriate medical equipment, and the charging of 94 community health workers who held peaceful protests outside the department’s head office, Bophelo House, in Bloemfontein in 2014.

Speaking to Spotlight prior to his court appearance, Motau would not go into specifics on any of these issues. He only said it “was a complex environment where it was like drilling into a stone to get water” when trying to deliver healthcare to 2.9 million people with budgets that he said, “you shout for till you are blue in the face”. 

Unfinished business

Motau also said there was unfinished business that he would have liked to have seen come to fruition in the Free State. This includes the impact of interventions such as shifting the priority of maternal mortality in the province. The Free State registers among the highest deaths of pregnant women and new mothers in the country. By getting a political principal to chair meetings on maternal mortality, he said he hoped to expedite decision-making and to free up budgets. He said he was also in the process of deepening collaboration with universities to introduce new health-related systems and was working to reach alternate agreements with the courts in liability cases.

His plan, he said, was to offer victims court-approved packages of care and services, not monetary pay-outs. The province’s contingent liability bill was skyrocketing. It stood at around R5 billion at the time he exited his post earlier this year.

“It will be difficult to turn that corner in the province because of the failures in the lower levels of care,” he said.

A brand eroded

Motau also has big plans for the HPCSA, although that future now seems uncertain in light of his court appearance.

Before this week’s events, and before Spotlight was aware of the charges, Motau in an interview with Spotlight reflected on his new role at the Council.

He acknowledged that “the HPCSA’s brand has been eroded” and that the Council has become removed from its members and also the public. He called out the “lack of urgency and agility” that has come to define the Council’s working culture and which has made it sluggish, clunky, and ineffective.

It’s become so removed from its members and also the public that at one point the Council simply chose to disable its social media platforms because of all the negative comments it was receiving, Motau said.

Formed in 1974 as a statutory body, it brings together 12 professional boards. The Council is meant to protect the public by setting and upholding standards, ethics, and a code of conduct for the education, training, and registration of practising health professionals. It is also supposed to protect and advocate for its members who have to pay subscriptions to the Council to be licensed to work. The HPCSA is funded by these subscriptions. Right now it is described as a going concern and in 2020 collected annual fees of R223 174 168 but its financial statements also reflect growing deficits that more than doubled between 2019 and 2020.

For years, the HPCSA has been dogged by poor governance, mismanagement, and administrative irregularities. Issues of conflicts of interest keep rearing its head as do the unsettled issues of the possibility of unbundling boards from the Council and the need for a clearer delineation of functions between its internal structures.

As far back as the end of 2015, a ministerial task team investigation found senior staff in the HPCSA unfit to hold their positions and highlighted widespread misconduct, irregular expenditure, and failure to efficiently manage operations. Drawn out Special Investigating Unit investigations from 2019, also finally saw precautionary suspensions of 16 employees implicated in bribery and corruption in registration processes in April this year.

Dr David Motau, former HOD of the Free State Health department during Dr Zweli Mkhize's visit to the province.
Dr David Motau (left), former HOD of the Free State Health Department during Dr Zweli Mkhize’s visit to the province. PHOTO: Department of Health

Planning to turn things around

Suspensions are part of the consequence management Motau spoke of in how he intends to get the HPCSA’s house in order. This while also working to improve the relationship with labour – the 265 staff members that make up the Council. “It’s your staff who has to implement your strategies and programmes and you can’t do that effectively if you’re standing outside the whole time receiving memorandums,” he said.

Motau said a different relationship means a balance of incentivising and tracking performance but also not carrying dead wood in the organisation.

“Your staff should feel like there’s a reason why they should get up and come to work each day but you also have to have signed performance agreements in place for deliverables they must meet. They should feel each day that they have earned their salaries, otherwise, they must look in the mirror and ask themselves what they are doing wrong,” he said.

“Your staff should feel like there’s a reason why they should get up and come to work each day but you also have to have signed performance agreements in place for deliverables they must meet. They should feel each day that they have earned their salaries, otherwise, they must look in the mirror and ask themselves what they are doing wrong,” he said.

Six weeks into the job, he said he has revived the HPCSA social media platforms – even at the risk of negative comments coming in fast and furious. He said he is working on digitalising more of their registration processes and listings to improve the user interface for members and the public.

He said he has also introduced quarterly staff assessments hoping to catch problems before they become crises at an annual review. “But if there is a question of clear dereliction of duty and you get to a point where you have to fire someone, then you must not be afraid to do that,” he said.

‘Tough love, silent compassion’

His presence in the office at a time when COVID-19 rates are still high is important for visible leadership, he said. Being in the office has meant he has also personally dealt with some routine complaints from members. This has included resolving issues for doctors waiting for months to receive their licence cards even as paid up members.

Motau described his management style as both “transactional and transformational”. Transactional in looking for performance and results and transformational in leadership that gets more buy-in.

“I’m not a command-and-control kind of leader. I would say I try to implement tough love and silent compassion,” he said.