Despite undertakings, still no permanent head of health in Northern Cape

Despite undertakings, still no permanent head of health in Northern CapeWaiting for healthcare at Augrabies Health Care Clinic outside Kakamas. PHOTO: Thom Pierce/Spotlight
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The Northern Cape Department of Health has been without a permanent head since 2020. In this time the department has had at least two acting heads of department (HoDs) – the latest being Dr Deon Theys, who has been acting in the position since 1 April this year.

Head of provincial government departments are appointed by provincial premiers.

In March last year (2022), Northern Cape Premier Dr Zamani Saul’s spokesperson, Bronwyn Thomas-Adams told Spotlight the recruitment process of a new HOD was in its “final stages”. Then, in February this year, she told Spotlight that the recruitment process for a HOD is underway and the appointment was expected in a month or two.

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When Spotlight asked the head of communications in the Department of the Premier, Monwabisi Nkompela about appointing a permanent HOD in the health department in mid-April, he said the appointment process is in its final stages and will be done in the next two weeks.

But this also was not to be.

Nkompela then told Spotlight on Wednesday (10 May), “The HOD post in the Northern Cape Department of Health has been advertised and the interviews are underway.” Nkompela said that Theys has applied and is among those shortlisted. He said they are waiting for the interview process to be finalised and hope “to have the post filled by June this year”.

Dr Deon Theys, when he was acting HOD in 2020.
Dr Deon Theys when he was acting HOD in 2020. He has now been reinstated as acting HOD after charges against him were withdrawn. PHOTO: NC Health/Twitter

Withdrawn charges

In April, Theys replaced Riaan Strydom, who was the acting HOD after Theys and the provincial health department’s CFO Dan Gaborone were suspended in 2021. They were both implicated in contravening the Public Finance Management Act relating to a R43 million personal protective equipment tender and were placed on precautionary suspension, the spokesperson for the National Prosecuting Authority in the Northern Cape, Mojalefa Senokoatsane said. He said the charges against Theys and Gaborone were provisionally withdrawn on 8 December 2022.

“What the NPA can confirm is that the matter is still being investigated,” said Senokoatsane, “as we believe that there is a case that needs to be answered by the accused. To ensure that the investigations are carried out with the sensitivity that they deserve, we won’t be able to share any additional information regarding the charges or people involved in this matter at this stage,” he said. Spotlight previously reported on the case here.

Northern Cape health spokesperson Lebogang Majaha confirmed to Spotlight that Theys is back as acting HOD. “Court charges against Dr Theys have been withdrawn, hence his return to the Northern Cape Department of Health,” said Majaha. “We will all agree that Dr Theys is a seasoned healthcare professional and that his inclusion as the acting administrative Head of the Northern Cape Department of Health will bring stability to the administration and accelerate the delivery of health services in the province. As the department, we welcome his appointment. We further pledge our support and we have full confidence in the leadership of Dr Theys.”

Theys declined to comment when approached by Spotlight for this article.

Northern Cape Health MEC Marupeng Lekwene (middle), CEO of Robert Sobukwe Hospital Dr Alistair Kantani (left) and acting head of the provincial health department Riaan Strydom during a press briefing.
Northern Cape Health MEC Marupeng Lekwene (middle), CEO of Robert Sobukwe Hospital Dr Alistair Kantani (left), and the former acting head of the provincial health department Riaan Strydom during an earlier press briefing. PHOTO: NC DOH/Facebook

Unions and opposition parties not happy

Meanwhile, unions and opposition parties have slammed Theys’ return to the position of acting HOD.

According to Cosatu’s provincial secretary, Orapeleng Moraladi, it is a sad state of affairs. “We condemn the step taken by government. Government needs to walk the talk. They say they are fighting corruption, but they have turned the health department into a hub for criminals. Even if charges were withdrawn, Theys still needs to undergo a disciplinary process. They treat matters as if they owe people favours, that is why nothing will improve in that department,” he said.

Denosa’s provincial secretary Anthony Vassen also expressed concern. “Due diligence must be done and there will always be this dark cloud hanging. We believe an official must either be cleared or arrested. Withdrawn charges mean nothing,” Vassen said. “However, we are willing to work with anyone that the department appoints. But this is going to impact the health system,” he said.

Nehawu, in turn, had a list of concerns over what the union deems the “below-par performance of the provincial health department”.

“We have always raised concerns about shortage of staff in health facilities, the poor working environment, including non-compliance with occupational health and safety,” said Nehawu’s provincial secretary Moleme Moleme. “We have called for the absorption of Community Health Workers, for them to address the lack of tools of trade, and to make permanent appointments in acting positions in management. What makes the problems worse is the lack of decisive leadership and poor management structures. Rather than dealing with root causes and when workers raise their dissatisfaction, they are hauled in front of disciplinaries while grievances and appeals are not handled by both HOD and MEC, respectively,” Moleme said. “Workers are on their own and they expect that we function productively in this anti-worker environment. These have serious ramifications for our community in terms of services rendered.”

Dr Deon Theys (middle) with Dr Zamani Saul, Northern Cape Premier during a visit to Warrenton CHC in 2020.
Dr Deon Theys (middle) with Dr Zamani Saul, Northern Cape Premier during a visit to Warrenton CHC in 2020. PHOTO: NC Health/Twitter

‘a dark cloud hanging’

Leader of the Democratic Alliance in the Northern Cape, Harold McGluwa insists that the Northern Cape Premier Zamani Saul must explain Theys’ re-appointment.

“The DA is concerned and we want Saul to explain his decision. The department has been without a permanent head since July 2020 and over the past couple of years, we consistently asked the Office of the Premier about the prolonged delay in appointing a permanent head. Last year, we were told that an advertisement had gone out in June and that the timeframes for the appointment would be provided to the committee, which they never were,” McGluwa told Spotlight. “On 24 March this year, we were told under no uncertain terms that an appointment would be made within two weeks. We are very disappointed that despite the commitment made to the legislature’s portfolio committee, a permanent HOD appointment has still not been made.”

McGluwa also expressed skepticism over Theys’ re-appointment.

“While some charges have been dropped, and he has not been criminally convicted, he was arrested twice within a six-month period during his tenure as acting HOD. Theys has a dark cloud hanging over his head and, given the extent of corruption within the health department, his appointment does not inspire confidence in the government’s ability to clean up the health department,” said McGluwa.

“The health department is on a downward spiral. Even the parliamentary oversight committee that recently visited the province raised serious concerns about the health department in the Northern Cape, of which the Premier is well aware. It needs a permanent head with unquestionable integrity and a proven ability to pull health out from its crumbling state, not a further questionable acting appointment to facilitate further regression,” he said.

Augrabies Health Care Clinic. One of the small town clinics outside Kakamas, where patients wait on the floor for the nurses to arrive. PHOTO: Thom Pierce/Spotlight
Augrabies Health Care Clinic in 2019. One of the small town clinics outside Kakamas, where patients wait on the floor for the nurses to arrive. PHOTO: Thom Pierce/Spotlight

Minimal progress

It is against this background that Parliament’s Portfolio Committee on Public Service and Administration conducted an oversight visit to the Northern Cape in March this year. The province’s Director General, Justice Bekebeke in a presentation to MPs showed that the health department is among the worst-performing departments in the province when it comes to frontline services, disciplinary cases, payment to creditors, and leadership instability.

Bekebeke was frank about challenges and told MPs that there has been minimal progress in the healthcare system of the Northern Cape over the past three years.

“Progress made is somewhat minimal, thus the effect thereof cannot be quantified,” he said. Bekebeke said there are current reforms such as primary healthcare re-engineering, Ideal Clinic realisation, National Health Insurance (NHI), and others underway that are aimed at reorganising the healthcare system to become more responsive, efficient, and to relieve the ever-increasing burden on service delivery demands. “However, it is bothersome because the same issues exist with no end in sight,” he said.

Patients waiting outside Alheit Primary Health Care Clinic outside Kakamas in the Northern Cape. PHOTO: Thom Pierce/Spotlight
Patients waiting outside Alheit Primary Health Care Clinic outside Kakamas in the Northern Cape. PHOTO: Thom Pierce/Spotlight

Among the issues he highlighted are “unresolved invoice discrepancies” relating to the poor payment record of the provincial health department. “Most departments are managing payments to creditors with the exception of the Department of Health, as 99% of the invoices older than 30 days not paid are reported by the Department of Health,” he said. By February, 2 554 invoices with a value of over R128 million remained unpaid.

He said challenges also include “IT system issues, inadequate budget challenges, and inadequate internal capacity”. On capacity issues, he told MPs that the provincial health department and education are the two biggest departments that get 70% of the provincial budget. “One of the greatest challenges,” he said, “was the non-alignment of the organogram currently in the health department.” On staff allocation, he said there are persistent delays in filling of the vacant posts for all the staff members. “There was a lack of senior managers who were able to take responsibility for their actions.” The health department is also among the departments with the most disciplinary cases. Between April and December last year, the total number of disciplinary cases stood at 184 with only 25 finalised in that time. There were 26 officials on precautionary suspension in that period costing the department over R29 million.

On the matter of disciplinary cases, Nkompela says the health department is not the only department with a high number of disciplinary cases. “There are three departments that have the highest number of disciplinary cases and not only the health department. The cases range from a variety of issues and not necessarily only corruption.” He said the provincial government is working together with law enforcement agencies such as the Special Investigating Unit, the Hawks, and the SAPS in dealing with corruption within government at all levels.

Bekebeke also highlighted security and infrastructure challenges.

According to him, all facilities monitored as part of the Frontline Service Delivery Monitoring Joint Annual Plan for the province failed to timeously adhere to maintenance plans and many facilities are too small to provide dignified health services as some of them are houses that have been converted into clinics. He singled out Kenhardt, De Aar, and Dr Torres clinics. Many of the facilities also “fail to comply with the safety regulations” in terms of emergency exits and safety certificates.

Many facilities also have no 24-hour security officer on site, he said, and the province’s district health information system is “unreliable” due to internet connectivity issues which make it difficult to connect with the Health Patient Record System. This means facilities often have to revert to a manual system for issuing patient files and this increases patient waiting times.