Last week MedicalBrief reported exclusively that Dr Rolene Wagner, the award-winning head of the Eastern Cape Health Department, was about to be sidelined. This week, writes Chris Bateman, it happened. Despite strong criticism from health activist organisations, Wagner has been moved, apparently in response to union pressure.
Eastern Cape Premier Oscar Mabuyane, who is battling runaway financial woes and dysfunctional delivery systems, has seconded her to a “capacity building” Covid-like command council that will be situated in his office. As HoD, Wagner eliminated R1bn in previous unauthorised expenditure and saved billions more in crippling provincial medico-legal bills.
She is one of five departmental heads to be transferred. Wagner incurred the displeasure of the unions with her robust turnaround and corruption-curbing activities and won a clutch of court victories against Nehawu during unprotected strikes.
The union celebrated publicly when rumours of her imminent removal from office peaked last month. She also came under the whip of her Health MEC, Nomakhosazana Meth, who criticised her in the provincial legislature.
Her chief director, S Gede, replaces her after sustained objections by the Rural Health Alliance and other health activist organisations. Mabuyane has yet to spell out the division of responsibilities, if any.
Wagner received a standing ovation from 200 delegates to the Rural Health Conference in Chintsa near East London last month after presenting her turnaround strategy. She has served two years of her five year-tenure.
Delegates were outraged when rumours emerged days after the conference that she was destined for removal in what was seen as a political move to assuage Nehawu and other healthcare unions.
Unions have traditionally held political sway in the Eastern Cape healthcare arena, with Health MECs failing to support hospital CEOs and HoDs during labour disputes.
The historical labour relations battlefield is littered with ousted hospital chiefs and bruised or removed HoDs, many of whom have since notched up significant court victories and/or cash settlements.
Mabuyane has good reason for acting decisively, albeit creating poor party optics in advance of next year’s national elections where the ANC will have to rely more than ever on the support of unions.
Half of the 39 municipalities in the Eastern Cape are on the brink of financial collapse and are being investigated by the Hawks for corruption. According to the Auditor-General’s latest audit, only four councils across the province received clean audits. Both metros – Buffalo City and Nelson Mandela Bay – maintained qualified audits.
In a media briefing on Tuesday, Mabuyane referred to his earlier State of the Province address in which he promised to set up a “crack team” in his office as part of capacity building. He had since renamed it the Project Support Unit, comprising “a high-powered team of leaders with proven capabilities and skills in public administration”.
“It is a team formed in the same spirit as the Provincial Command Council that worked like a well-oiled machine in the fight against the Covid-19 pandemic,” he said.
He listed investment co-ordination, local government support, driving education and health turnaround strategies and designated groups’ co-ordination and state machinery transformation, plus pushing strategic and catalytic projects as “critical areas identified as lagging in our monitoring and evaluation processes.”
“I want a full hands-on -deck approach in these areas for maximum progress and impact,” he asserted.
The Project Support Unit would require cross-cutting functions of social facilitation, change management, communication, back-office support, systems, and operations.
His office had entered into secondment agreements with the officials and their respective departments for 12 months and there would be no vacuum where heads of department were concerned, “because they put sound systems in place”.
Acting HoDs would be: D Venn (Human Settlements, that department’s chief director), V Mlokoti, (Cooperative Governance and Traditional Affairs, DDG in that department), M Madumane (Transport and chief director at the Provincial Treasury), S Gede (Health, chief director in that department), B Dayimani, (Dept of Rural Development and Agrarian Reform, CEO within that department).
Mabuyane boasted that the number of departments “and entities” that had received clean audits had grown from five in 2018/19 to 15 in the 2022/23 performance cycle, adding that unemployment in the province had declined from 47.9% in the fourth quarter of 2020 to 39.7% in the second quarter of this year.
Wagner declined comment when approached by MedicalBrief.
However, in her address to the Rural Health conference last month, she said that had her department not launched an integrated medico-legal strategy, a total of around R2bn was likely to have been lost. This was curtailed to under R500m, R380m of which was for liabilities accepted before her time.
“We persuaded the courts to allow us to pay that liability through a payment plan and setting up Centres of Excellence for cerebral palsy, (CP), rehabilitation rather than lump sum settlements,” she added.
There are 2 812 CP children recorded in the province, about 1 000 of whom are receiving provincial rehabilitation services at hospitals, officials said. The remainder, whose parents were discouraged by the Covid pandemic, are gradually being tracked down by community health workers.
Wagner’s “Health Management Standards” (Version 2), conceptualised and developed at Frere Hospital when she was CEO there, was been rolled out to 26 hospitals and three EMS units in the province, plus six hospitals in the Free State. It has since been punted as the national standard for electronic health records, (as SA move towards an NHI), she told delegates.
Her department saved “around R45m” annually to date because it owned the intellectual property and thus saved on licences and software development. Her medico-legal modules “help us track and manage our continent liability associated with medical negligence”, she added.
“We’ve reduced teenage pregnancies in one year by more than 1 300 girls aged 10-19 and expanded the number of community healthcare workers for our ward-based outreach teams,” she told delegates.
Her department employed some 13 500 healthcare workers last year, including replacements, placing them at rural facilities and priority sites.
• Wagner was named one of Africa’s most influential women while CEO of Frere Hospital in 2017 when the International Hospital Federation honoured Frere for its turnaround quality improvement. In 2016 she won the SA Businesswomen’s Association ‘Woman of the Year’ award in the government category.
See more from MedicalBrief archives:
Eastern Cape Health boss under fire in ‘political clean-out’
DA: New superintendent-general is qualified but Eastern Cape Health is a sinking ship
Eastern Cape ruling could change how medico-legal claims are settled