Ask the right questions to prevent further tragedies
Two significant reports were released by the government in recent weeks: Towards a Fifteen-Year Review; and a damning task team report on the investigation of the deaths of 140 Eastern Cape infants during the first three months of this year.
The babies’ deaths were attributed to a combination of poor living conditions, contaminated water and abysmal healthcare. Both reports speak to what has been achieved the past 15 years.
The review was released by the shaken-up Presidency, while the task team report was made public by new Health Minister Barbara Hogan. The review’s main finding is positive: “Much has been done to eradicate the legacy of apartheid and build a new, just society; and the foundations laid in the first 10 years, together with new initiatives since 2004, have enabled SA to notch up a faster rate of growth and development.”
Notwithstanding significant progress in macroeconomic management and service delivery, the appalling treatment of mothers and children in Eastern Cape hospitals received far greater media attention than the review.
The review, using external consultants, was initiated last year under the Mbeki administration to take “stock of progress, since the attainment of democracy (but especially over the past five years), in achieving the objective of improving the quality of life of all South Africans”. But the review also makes clear that it is intended to identify challenges and shortcomings, in order to advance planning and delivery, as well as to facilitate public debate.
This is welcome but not necessarily practical given the groupings of the report into government clusters, which become so broad that local government, for instance, the source of so many service delivery protests, does not receive separate attention.
A major theme relevant to the Ukhahlamba, Eastern Cape, tragedy is inequality, although the review lays the blame at the door of the “reproduction of existing disparities in ownership, income, resources, skills and other determinants of people’s capacity to take advantage of opportunities”, rather than unpacking how fiscal spending can perpetuate inequality.
Comparing total expenditure in Ukhahlamba and the four local municipalities within its boundaries against the nine largest South African cities between 2003-04 and 2006-07, reveals that the district spent an average of R749 per resident per year, while the nine largest cities spent an average of R3118 per resident per year — four times more (see graph).
The poorest of Ukhahlamba’s municipalities, Elundini, spent an average of R316 per resident per year over the period, while the richest of the nine cities, Johannesburg, spent on average R4084 per resident per year — almost 13 times more than Elundini.
If you were an infant of a poor South African mother, where would you rather be born? There is little evidence in this comparison that much has been done to “eradicate the legacy of apartheid and build a new, just society”.
No doubt, the review’s analyses of trends — such as household size and structure; the economically active population and unemployment; migration; social cohesion; inequality; state legitimacy; national leadership; and social partnership — are all crucial for researchers and officials. Based on this analysis, the review urges: speeding up growth and transforming the economy; fighting poverty; building social cohesion and state legitimacy; international co-operation; and building an effective developmental state.
But is this practical enough to address failures?
Consider the findings of the task team of three specialists pointing to nothing simpler than poor medical care. In the Empilisweni Hospital children’s ward, where most of the Eastern Cape deaths occurred, there were found to be no nurses’ stations or work surfaces, no separation of “clean” and “dirty” areas, inadequate and inappropriate services, overcrowding, and no treatment protocols or reference materials.
Most of the 45 child victims died of diarrhoeal disease, pneumonia and malnutrition within 48 hours of admission, without being weighed or having their HIV and nutritional status assessed. A strategy to encourage preventative care and the delivery of infection control equipment, diarrhoea medication and food parcels has since reduced the number of infant and child deaths due to diarrhoea in the district.
Notwithstanding the value of these findings, the focus on healthcare issues removes much-needed scrutiny from the local governance failure that gave rise to contaminated water.
In a management consultancy context, rather than the broad imperatives concluded in the review or those specific to the hospital level of the task team, crises such as that at Ukhahlamba would be interrogated in a comprehensive way to address systems failure — why was the water quality not properly tested and, when it became clear purification was failing, why was this not rectified by local government? Why did the district council not liaise with health authorities (or vice versa)? Why did the provincial health department take so long to respond with equipment, personnel and information to the emerging crisis? Where was national government? Most importantly, who is accountable?
An appalling governance failure is apparent. Not only did municipal officials fail to deliver basic services, but they failed to release a public health warning or full reports on the crisis.
Medical staff at district hospitals not only ignored basic health protocols but showed callous indifference in charging mothers to lie on the floor next to their critically ill babies.
Ukhahlamba is one of the poorest districts in SA, but it is not the poorest. Combining figures of income inequality, unemployment and access to basic services, the district is better off than almost 40% of South African districts. The pressing question is, if the collapse of so many basic governance systems should occur in Ukhahlamba, how many other munici-palities are similarly vulnerable?
Recalling Ghandi’s criterion — “A nation’s greatness is measured by how it treats its weakest members” — can it truthfully be said that “the macro-structure of the state is well established and fairly functional”? Perhaps the underly-ing complacency of the review, published without so much as a reference to the Ukhahlamba disaster, against the candour and transparency of Hogan’s short tenure as minister, suggests that, at least at some level, the shake-up in the executive is much needed.
Although the review recognises that more decisiveness and flexibility may be required of the state, the very tenor of its generalities point to a failure in practical co-ordination, monitoring and planning, for which the Presidency is responsible.
Perhaps new leadership will add a sense of urgency and momentum to this role. It can only be hoped so, if the next five years of democracy are to deliver up to their much-vaunted promises to build a new, just society; and, speaking of justice, that perhaps a class action suit is filed to bring some accountability and closure for the mothers of the dead babies of Ukhahlamba.