Eastern Cape director-general for Health, Dr Rolene Wagner, who has eliminated R1bn in previous unauthorised expenditure and saved billions more in crippling provincial medico-legal bills, is reportedly in line for the sack, along with several top administrative colleagues.
Chris Bateman, writing for MedicalBrief reports that the expected clean-out follows dissatisfaction with alleged ‘non-performance,” by Wagner, Co-operative Governance & Traditional Affairs HoD Andile Fani, and Human Settlements HoD Tabisa Poswa.
Eastern Cape Premier Oscar Mabuyane is ostensibly acting to turnaround his province’s dismal overall financial performance – but healthcare veterans at the coalface believe it’s a pre-election ploy to mollify the ANC’s powerful union allies, particularly Nehawu, ahead of next year’s elections.
Wagner confirmed that she was on leave and that an acting director-general was now ensconced in her place, but declined further comment, saying her provincial health turnaround strategy document was ‘a matter of public record.’
She is known to have presented it to National Health Minister Dr Joe Phaahla when he visited the Eastern Cape during the first half of September.
Wagner received a standing ovation from 200 delegates at the Rural Doctor’s Conference of South Africa when she presented her turnaround strategy document and review at Chintsa near East London in mid-September.
Widely held sentiment among veteran Eastern Cape healthcare workers is a dejected sense of ‘déjà vu’ as a familiar pattern of Premiers firing competent CEOs and HoDs after protracted conflicts with unions and Health MECs seemed to be on the verge of repeating itself. A predecessor of Wagner’s, Dr Siva Pillay, (2010-2013), had his contract suddenly terminated after taking on Nehawu in the courts and winning (as has Wagner). Several Eastern Cape hospital CEOs or managers have been suspended or placed on precautionary leave after unprotected union strikes at their institutions, at least one of them (Dr Roger Walsh, former CEO of Fort England Psychiatric Hospital, won several million in a Labour Court judgment after being on paid leave for a year). The reason usually cited by incumbent politicians is that the healthcare leaders ‘had to be removed to calm volatile labor relations’ and enable proper healthcare. Both Pillay and Wagner clashed with their respective MECs.
In a statement on 21 September, Nehawu provincial secretary, Mlungiseli Ncapayi, said they ‘welcome the decision by the Premier to hold accountable all the underperforming senior managers, including the Health HoD.”
Ncapayi added “it has long been our conclusion that Wagner has no capacity to resolve all the complexities of the provincial health system”.
A spokesman for the Eastern Cape Health Department, Mkhululi Ndamase, confirmed that Wagner was on leave, ‘in line with any staff member’s annual leave allocation.’ However, he declined to comment on a detailed list of questions, including the highly visible practice of firing competent hospital CEOs and health HoDs whenever unprotected strike action or hospital disruption occurred.
A spokesperson for the Eastern Cape provincial administration, Khuselwa Rantjie, told MedicalBrief yesterday that neither Wagner nor any other HoD’s removal had been on the agenda of a cyber exco meeting that day. She declined further comment on Dr Wagner’s continued tenure (three years to go), asking for written questions.
In Wagner’s turnaround strategy document, she says her department stemmed the ‘hemorrhage of funds’ due to lump sum medico-legal settlements.
“Had we not launched the 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 prior to my time. We persuaded the courts to allow us to pay that liability through a payment plan and setting up Centers of Excellence for cerebral palsy, (CP), (rehabilitation rather than lump sum settlements,” she added. There are 2 000 CP children officially recorded in the Eastern Cape, 1 000 of whom are being cared for at provincial facilities.
Wagner’s ‘Health Management Standards” (Version 2), conceptualised and developed at Frere Hospital when she was CEO there, had 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 moves towards an NHI), she told delegates.
Her department had saved ‘around R45m’ annually to date because it owned the intellectual property and thus saved on licenes and software development. Her medico-legal modules ‘help us track and manage our continent liability associated with medical negligence,” she added.
On the clinical services side, Wagner said her team improved surgery and orthopedic capacity at selected regional, tertiary, and central hospital hospitals and planned to expand this to 28 district hospitals.
“We’ve reduced teenage pregnancies in one year by over 1 300 young girls ages 10-19 years and have expanded the number of community health care workers for our ward-based outreach teams,” she said.
Her department employed some 13 500 healthcare workers last year, including replacements, placing them at rural facilities and priority sites.
“We’ve invested in plant, machinery and equipment so that our doctors have digitalised X-ray diagnostic capability; and we’ve have ordered CT and Linac machines for two major hospitals,” she told delegates.
So far 47% of R1.6bn had been allocated for maintenance of healthcare facilities with R220m decentralised. In January last year her department set up a database of contractors to respond to emergency repairs, appointing professionals to conduct additional assessments, “so we know what needs to be repaired and/or replaced.”
Provincial health officials close to Wagner said she went out of her way to engage unions, the latest dispute being over rural allowances for enrolled nurses and enrolled nursing assistants.
Some 19 Eastern Cape registered nurses recently won a provincial Labour Court victory allowing them rural allowances and their colleagues subsequently went on an unprotected strike demanding the same and threatening to bring the health system to its knees. However, Wagner is challenging what she contends is a flawed ruling based on several other provinces having also challenged it – and winning.
The unions had declared a ‘programme of action’ which began with a march which the MEC for Health, Ms Nomakhosazana Meth supported, the veteran official added.
In recent months, Wagner dismissed 187 emergency service workers who took part in an unprotected strike which saw the homes of two ‘scab’ workers burnt to the ground.
During her two years as HoD, Wagner moved her department from a financial disclaimer to no qualifications after audit.
“It’s little wonder, the unions are totally against her – and the politicians need to keep them onside,” another senior provincial healthcare worker added.
Dr Xolisile Ngumbela, a senior researcher at the School of Public Management, Governance and Public Policy, College of Business and Economics at the University of Johannesburg, said the provinces’ reportedly aspirant top management ‘putsch,’ was ‘ill-informed and a symptom of panic.”
“Oscar Mabiyane is panicking, and the ANC can see that due to poor governance and service delivery, they’re losing numbers. These caretaker-HoD’s are going to be put there to ‘fast track’ service delivery so that the electorate can see something is being done,” he added.
He questioned what they could do in the short time before elections next year when HoD’s contracts ran for five years.
“Also, they’re now joining the Office of the Premier – how will that make certain individuals perform? It’s very naïve, ill-informed, and hasty – the Premier knows it will be difficult to win the hearts of the people,” he added.
The Daily Dispatch reports that Wagner's department is accused of having failed to fill more than 1 000 critical posts in the ailing Eastern Cape Health Department.
These include the critical post of nine CEO positions for some of the top hospitals in the province: Frere, Nelson Mandela Academic, Livingstone, Dora Nginza, Jose Pearson, St Elizabeth, Fort England, Tower and Komani Psychiatric hospitals.
The Rural Alliance Health said the decision made by provincial government authorities would have a detrimental effect on the roll-out of health services in the province, which was starting to see a remarkable turnaround under the stewardship of Wagner.
The alliance said the provincial government should urgently rethink its decision on Wagner.
Rural Doctors Association of SA chair Dr Lungile Hobe said: ‘Dr Wagner is not the problem. The Eastern Cape has systemic challenges that need systemic solutions.
The Rural Health Alliance said the province had been held hostage by an ongoing health crisis for the greater part of the past three decades.
‘Since the onset of democracy these have included infrastructural challenges, shortages, stockouts, overcrowding and staffing issues.
‘Dr Wagner was appointed as HOD in August 2021 and has been in the process of implementing a provincial turnaround strategy which has been addressing the critical challenges facing communities in accessing health and care.
‘Dr Wagner and her team have been systematically juggling different priorities needed to ensure that service delivery continues, and still address underlying root causes such as the depletion of funds through medical litigation.
‘This has included bringing in measures to manage huge accruals from previous years and stabilising the dire financial situation of the department,’ the statement reads.
‘The Rural Health Alliance calls on the Eastern Cape Government to reappoint Wagner and to reconsider the healthcare needs of the 6m people in the province who need equitable access to quality healthcare,’ Hobe said.
The Office of the Premier director-general Mbulelo Sogoni wrote to Wagner in August, expressing concern at the department’s failure to fill more than 1 000 critical vacant posts, including those of nine CEOS.
Daily Dispatch – Doctors defend health boss Wagner who faces the axe