With a new head, there is quiet optimism that a turnaround in the Free State Department of Health’s fortunes could be imminent, write Spotlight’s Ulfriedo Ho, who talks to Masechaba Sesing about her plans for the department.
Interest in Sesing’s appointment has stirred equal parts controversy, confusion and cautious hope that the beleaguered department – in a beleaguered province – can steady itself.
Sesing has been here for about five months, assuming the position last November after seven years at the provincial Treasury as HoD.
The chartered accountant previously worked at the Auditor-General of South Africa. Previously, she had stints on international audits for the United Nations and the African Union.
Her transfer from Treasury to Health was surprising for some. It came after the Treasury had achieved three successive clean audits under her leadership. A shift to Health could have been seen as a demotion.
Sesing did run into some headwinds at Treasury though, including allegations of inappropriately interfering in the appointment of senior staffers. It led to her being investigated by the Public Service Commission in two separate cases. She allegedly favoured candidates with whom she supposedly had personal connections. One case was found to be unsubstantiated; the second is ongoing.
Sesing has denied acting improperly.
Against this background, she took up her role as Health HoD – considered among the most complex in provincial government, overseeing what is usually one of the two largest budget allocations in the province.
Optimism in the face of challenges
There has been optimism from some for what they see as her willingness to act on fraud and poor management. Her financial background is regarded as an advantage to right a department crippled by years of corruption and maladministration allegations.
Challenges include the payment of ghost workers, long unfinished infrastructure builds, alleged overpayment for inferior equipment, high debt to suppliers, and an absent budget to prioritise the filling of around 5 000 vacancies.
She also has to navigate thorny and unstable provincial politics.
The Free State has been led by Premier MaQueen Letsoha-Mathae since June 2024. By August that year, she faced court action over a planned reshuffle of HoDs. Mosa Masitha, who was HoD of the Human Settlements Department, challenged her transfer to the Social Development Department. She argued in court papers that her contract was meant to run till September 2027, that she had not been properly consulted about the move.
The Premier and Tumelo Phahlo, who at the time was appointed in Masitha’s place at Human Settlements, were found in contempt of court when they failed to arrive for proceedings. They were ordered to jointly pay costs and Letsoha-Mathae was ordered to reinstate Masitha.
This did not happen. Masita is now HoD of Public Works and Phahlo is HoD of Social Development.
Letsoha-Mathae’s critics have slammed her leadership style as dictatorial and claimed that some of her decision-making disrupted efforts to improve the running of the province.
In October, the Premier and her husband Lawrence Mathae, who is Speaker of the Mangaung Metro, came under investigation. The Directorate for Priority Crime Investigation (the Hawks) is investigating allegations of corruption and money laundering to the tune of R4.5m linked to a road construction tender while the Premier was MEC for Community Safety, Roads and Transport.
The couple has denied the allegations.
‘Health was keeping her awake at night’
It is amid this volatile political climate that Sesing spoke to Spotlight at the end of February. Publication of the interview was delayed due to speculation that she was to be moved out of the department.
Health Department spokesperson Mondli Mvambi told Spotlight the rumblings in mid-March of another reshuffle were “speculative” and “only rumour”. The Premier’s office did not respond to Spotlight’s questions.
Sesing was asked about politics and precarity and how she intends navigating these in a department she has landed in as an outsider.
“It would have been nice to continue at Treasury because I had already done a lot over the past seven years. But I don’t blame our political principals for moving us around …they want to see changes, impact and service delivery,” she said.
Her relationship with the Premier is a good one, she said, adding that she didn’t feel slighted when moved to Health.
“I know that the Premier has good intentions, and has my best interest at heart. (The move) was something she personally spoke to me about. I knew that among other departments, Health was one that was keeping her awake at night.”
‘We need to be productive’
She said that people working in government often become complacent. “In the private sector, you won’t sit for long without performing. So, it’s high time we government officials wake up to the reality that we need to be productive.”
Since taking up the role, Sesing has been making unannounced weekend visits to clinics and hospitals. The aim, she said, is to go beyond reports and spreadsheet data to truly understand the realities at facilities.
“I don’t arrive in a place believing I am working with crooks, so we begin with understanding what is happening – could it be a case of needing training or better tools?”
For Sesing, being on the ground is a way to build a foundation for consequence management. This style of management is needed to change organisational culture and build efficiencies in the department, she said.
“Consequence management is not punitive and the employee should know what is coming because they should understand, at every point, what is expected of them. And we need to build efficiencies, otherwise whatever money we have in a budget will never be enough.”
Need for better financial discipline
The Free State Health budget stands at R13.71bn, a 4.8% increase from the previous year. Sesing stressed the importance of financial discipline to make this money go further.
She outlined a few priority targets toward this objective.
“The department is supposed to pay the South African Revenue Service and other third parties in the last month of the financial year, but that’s not what’s been happening. Everyone, from hospitals, to the different departments, and municipalities, must be submitting their financials, but that has also not been happening,” she said.
Currently, the department has achieved only one part of a three-part checklist to qualify for a clean audit.
“I want to work on bringing down irregular expenditure, to get to the bottom of why there are procurements happening outside government’s prescripts,” she said.
Sesing said the deterioration of healthcare services has been dire. She wants to understand nurses’ workplace challenges, but at the same time to address why productivity and professionalism continue to be flagged as problems by patients.
‘Professional and kind’
The mother of two, who grew up in Driehoek, was raised by her grandparents in her early years as her single mother looked for work in Bloemfontein.
Sesing said she remembers going to Pelonomi Hospital in Bloemfontein as a child in the late 1980s, where her mother had regular check-ups for her back.
“I remember the floors at Pelonomi were the shiniest I ever saw. The nurses were in all white and they were so professional and kind. I found myself dreaming that I wanted to be part of them. I remember they also gave me lunch – mashed potatoes, peas, pumpkin and chicken. And when they saw I was finished, they would give me malva pudding and custard. I wished my mother could have check-ups every day. But if you go there now, it’s the flipside of this,” she said.
Pelonomi suffers from surgical backlogs, and ongoing reports of basic medical supplies and equipment shortages. On an official government visit to the hospital in July last year, the Premier criticised the long waiting times. Patients who arrived at 7am were still waiting by 1pm.
When asked, Sesing admitted that the only public health facility she would be comfortable using in the province is the Universitas Academic Hospital.
She also acknowledged that the province is lagging in being ready for any implementation of National Health Insurance. Only four facilities at a district level meet the “100% criteria for the ideal hospital or the ideal clinic” to fulfil the aspirations towards universal health coverage. The key block is unfinished infrastructure builds.
She committed to a three-year timeframe to bring infrastructure to an acceptable state.
‘I don’t take a lunch break’
She homed in again on work ethic and leadership, adding: “Nurses have every right to take their breaks and their lunchtime but we need to understand that doing the bare minimum will not save our health system or patients if we are serious about preserving lives.
“I remind the nurses I meet that I don’t take a lunch break – maybe once every six months. I’m also at work by 6.30am or 7am, and leave later than most people. When people hear this, then they understand that we are in this struggle together.”
It’s the reason Sesing is enraged by ghost workers. These fake staff have bled the department’s payroll for years. The province announced in its latest budget that it had identified 225 phantom workers – and 21 people found to be involved in the scheme to steal were eventually dismissed.
“I will have no mercy for that,” she said.
Three targets
Sesing outlined some targets for things she wishes to see improved.
Within the year, she wants accruals and other debts reduced by 30%. Accruals mean that hospitals and the department as a whole begin each financial year having to settle outstanding accounts from the previous year. Little is left over for new projects or new essential acquisitions and procurements.
Her second target is to reduce irregular expenditure by around 15%, or R300m.
Her third target is to reduce the hours-long waiting times at clinics and hospitals.
According to the latest Free State report from community healthcare monitoring group Ritshidze, provincial public healthcare users spend an average of more than four hours in a clinic queue. Some patients arrived as early as 5.30am to be near the front of the queue, with about 81% of those surveyed saying waiting times were too long.
“People are impatient for change because things have gone wrong for a long time in the department. I understand this. But believe me, we as a collective, we are working very hard to close these gaps,” Sesing said.
‘Moving people around’
For the Democratic Alliance, the official opposition in the province, Sesing’s appointment should not have taken place while an open PSC investigation into her remains open.
David Masoeu, member of the Free State legislature and DA spokesperson for health and social development, said the ANC’s practice of cadre deployment continues to leave the door open for political meddling.
“The ANC in the Free State is known to move people around the minute they feel that person is trying to clean house or is not acting in a way that benefits them. We cannot have a case where HODs are manipulated,” he said.
He said he hoped Sesing would be open to building a better working relationship with his party, including allowing oversight work not limited to portfolio committee reports to take place.
“We know there are many problems here, so we need to be out there doing oversight. It’s the huge staff shortages across all categories and issues of infrastructure and backlogs of surgeries. Right now, the main mortuary in Bloemfontein is closed and autopsies have had to be done in Welkom. Families tell us they can wait three months to receive bodies for burial.”
For Brian Motshabi, provincial secretary of the Democratic Nursing Organisation of South Africa (Denosa), Sesing’s financial qualifications were reason to be excited that the department might get its house in order.
“One of the areas concerning us is corruption and maladministration. Members tell us about problems with medical consumables that are overpriced but of an inferior quality,” he said.
“There are also issues like renovations that are not completed but the money has already been spent – like Boitumelo Hospital in Kroonstad, and the maternity ward at Pelonomi Hospital that has been going on now for more than a decade.”
He said Sesing has done well on acting speedily on some issues brought to her attention, including resolving the issue of unpaid uniform allowances for nurses. But they are still battling to have overtime paid timeously.
Also high on Denosa’s agenda is the need to employ around 1 200 clinical workers who were part of the Covid-19 supplementary staff but were not given permanent posts – and the same goes for many people stuck in acting positions. Added to this, Motshabi said people who needed to be fired should be fired, not moved sideways or on drawn out, costly suspensions and disciplinaries.
Motshabi said the HOD’s work in the coming months and years must remain in the spotlight because of what’s at stake. “The health department is one with a huge budget, so obviously there are those who want to get their hands on it,” he said.
This article was first published by Spotlight – health journalism in the public interest.
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