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'Dysfunctional and an embarrassment' – outgoing Ombudsman on health departments

In a blistering reflection of the public health sector after seven years in the job, outgoing Health Ombudsman Professor Malegapuru Makgoba labelled the system 'dysfunctional', with the Gauteng and Eastern Cape departments bearing the brunt of his scathing criticism.

The Eastern Cape Health Department is an “embarrassment”, and Gauteng’s is “problematic”, “changing its CEOs (like) panties”, Makgoba charged, saying the two departments were South Africa’s most dysfunctional.

Both lacked progress, leadership, capacity or vision, he said, while the Free State Health Department was characterised by “disorder and no harmony”.

Makgoba, who described his office as independent and not beholden to any political party, said the only province that “seems to have got its act together is the Western Cape”, reports TimesLIVE.

He said of the more than 10 000 complaints his office had received, half were from Gauteng, which he said was “run like Eskom” and lacked stability due to frequent changes of top leadership, resulting in poor service delivery.

Makgoba said an investigation into Rahima Moosa Mother and Child Hospital in Gauteng found that “the criteria for appointing the leadership of hospitals is the weakest”.

His office also found the hospital to be unsafe, filthy, neglected with crumbling infrastructure and disrespectful to patients.

“Gauteng… is the showcase province. You have your best province run by Mickey Mouse … what do you expect? You expect what you are getting … a service that is in shambles. A service that doesn’t really deserve what it is.”

While there is no comparison between Gauteng’s wealth and Limpopo’s, Makgoba said Limpopo was managed by a stable leadership and had had one MEC (Dr Phophi Ramathuba) for a long time.

“Here (Gauteng) they change CEOs like, I don’t know, panties …”

As for the Eastern Cape, “…the provincial Health Department is really an embarrassment, but that’s for the Minister to deal with at some point”.

Makgoba said while his office often faced appeals and legal challenges, in the past seven years none had succeeded and his findings had not been overturned by any court.

“I think this is testimony to the quality of the investigators and the investigations we do. The principle of quality is measured by the reports you produce that are overturned by the courts.”

Being independent was one of the principles of his office, and staying impartial was crucial, he said, adding that he had never been influenced by any of the three Health Ministers under whom he had served, nor had they interfered with his work.

However, while “the inaugural watchdog of SA’s health services must have seen and heard some harrowing things”, what was really needed for the job was someone “who will make lazy, corrupt, ineffective and negligent health bosses shake in their boots”, a TimesLIVE editorial said last week.

Because despite his office’s criticisms and exposures – the Life Esidimeni tragedy, and most recently, the Rahima Moosa Mother and Child Hospital situation – “the results were less than impressive”.

“His office had also investigated the case of Shonisani Lethole, who died in appalling conditions at Thembisa Hospital in June 2020, shortly after tweeting then Health Minister Zweli Mkhize about his desperate plight. The investigation found Lethole had not been offered food by the hospital for a total of 100 hours and 54 minutes.

“But last year Lethole’s family bemoaned the slow progress of Gauteng Health in implementing the ombud’s recommendations, which included addressing certain management failures, mediation with the family and more.”

The family said a failed attempt at mediation with the government had “left us with no option but to pursue legal action”.

The ombud is a facilitator, designed to mediate, conciliate, investigate and make recommendations – it has no power to go any further, and relies on other sources to follow through, said the editorial.

it added there was "no doubt the ombud’s office has contributed hugely to holding government to account for some of its failures and shortfalls – for example, in the Life Esidimeni case heads have rolled, and an inquest is ongoing.

But what happens to those cases that fly under the radar and do not make headlines?

“Are there always real consequences for those who have been found wanting? Does the threat of an ombudsman probe strike fear into the hearts of hospital CEOs and healthcare workers?”

Last week, Makgoba suggested the Health Ombudsman should be a separate independent office, in line with international best practices. His suggestion should be seriously considered by government, if it is truly committed to improving healthcare, suggested the editorial.


TimesLIVE article – They change CEOs like panties': outgoing ombud lashes ailing Gauteng, Eastern Cape health departments (Restricted access)


TimesLIVE article – EDITORIAL | Health ombud’s office needs a new sheriff with teeth (Restricted access)


See more from MedicalBrief archives:


Callous disregard at ‘dirty’, ‘filthy’, ‘unsafe’ Rahima Moosa – Ombud


Good doctors require empathy – outgoing Health Ombud Makgoba


Nine Gauteng hospitals still without permanent CEOs


DA calls for Eastern Cape Health to be placed under administration









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