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Esidimeni: Gauteng premier had ordered that cost cuts should not affect core services

David Makhura

As the Life Esidimeni hearings wrap up, retired Justice Dikgang Moseneke‚ said he was still 'struggling' to work out the reasons for the tragedy. Gauteng Premier David Makhura told the hearing he had always emphasised cost cutting measures should not be done to core services.

The hearings aim to find out why 1‚700 mentally ill patients were moved from three psychiatric homes into ill-equipped NGOs in 2016‚ leading to the deaths of 143 patients, and were also set up to give closure and financial redress to the victims' families.

The report says retired Justice Dikgang Moseneke‚ who is chairing the hearings‚ told the second last witness‚ Premier David Makhura‚ he was still "struggling" to work out the reasons it happened. Moseneke said to Makhura: "The families are still struggling with the decisions and the real motives." Makhura said: "I am struggling with understanding the motive." "Could it be money?" asked Moseneke. Makhura said he hoped the Special Investigating Unit would shed more light on events.

The report says Makhura was in charge of the Gauteng government when the move from the homes happened in 2016.

Since the very first week of the hearings in October‚ Moseneke has asked most witness what drove the decision of the Health Department to move patients into ill-equipped‚ illegal NGOs. Seniors officials testified there was severe financial pressure on the department and ending the contract with Life Esidimeni homes was a cost-saving measure. Former MEC for health Qedani Mahlangu said under oath: "You rob Peter to pay Paul at any one time."

But, the report says‚ Gauteng Finance MEC Barbara Creecy, testifying at the hearings, said cost cutting was never supposed to lead to departments stopping essential services. She said government departments were meant to reduce spending on entertainment‚ travel‚ venues‚ catering and consultants.

The report says Makhura started off his testimony at the hearings apologising to the families. "Apologising doesn't mean a lot if there is no truth. At the end of my testimony‚ families will come closer to the truth‚" he said. But while witnesses have explained what happened‚ they haven't said why.

Creecy also apologised that the tragedy happened under her watch as Finance MEC. She said it was a "series of events that filled her with shame". But she doesn't know why they occurred.


Makhura told the hearings that Mahlangu told him the deaths were normal when he asked for an explanation about the number of people dying. A Destiny Man report, quotes Makhura as saying when he found out about the deaths, 36 patients had already died as a result of the botched marathon project. He explained that he called Mahlangu and held a meeting with her the next day.

Mahlangu was in the company of former head of mental health Dr Barney Selebano. “I held a meeting with MEC Mahlangu and her team on the 14th September 2016, I wanted an explanation on what caused the death, they said its normal,” Makhura said.

The report says Makhura admitted that he knew about the termination of the contract with Life Esidimeni, but he always emphasised during each budget council meeting that cutting costs measures, should not be done to core services. “We always said, if you want to re-prioritise, it’s not about cutting cost. Want to emphasise that costs were never an issue.”

The report says Makhura’s testimony trashed Mahlangu’s evidence that the Health Department was under financial constraints and closing Life Esidimeni was intended to cut costs as ordered by the Treasury. The premier said he was given assurance by Mahlangu and Selebano that everything was on track. “And now we know that none that happened. The MEC and HOD went ahead and shut down Life Esidimeni. Workers lost their jobs and patients lost their lives,” said Moseneke.

Makhura explained that he was further reassured by Selebano and Mahlangu that employees will be absorbed in the department. “The possibility of absorbing those workers in the new project was not unrealistic. MEC and HOD said we have no problem with (the National Education, Health and Allied Workers’ Union [Nehawu]). We don’t know why you are coming in. We will keep engaging Nehawu. That was their assurance to me,” Makhura said.

The report says Moseneke asked Makhura if Mahlangu reported this to him. “I spoke to all of them in one sitting, none of them said anything about being misled or afraid,” he replied.

“Why did the MEC resign, was she was pushed or did she jump?” asked Moseneke. Makhura said he always maintained that when something goes wrong in a person’s line of duty there will be consequences and Mahlangu said she will resign if needed.

Makhura explained that everyone should take individual accountability for their role in the deadly project. He vowed to implement the recommendations of the health ombudsmen to rectify the deficiencies in the department.

The report says in the beginning of his testimony, Makhura apologised to the families and promised to answer questions of what he knows and assured families that he won’t to shift blame. “I am here to account as per the constitution…We know that apologising doesn’t mean a lot of there is no truth. I hope the families come closer to the truth…I will work with the families to pursue justice elsewhere,” he said.


Makhura says that he spoke to Mahlangu about resigning over the tragedy, telling her he would have to take decisive action against her if she didn't, reports Eyewitness News. Makhura says that when he read Health Ombudsman Professor Malegapuru Makgoba's interim report into the tragedy he immediately called Mahlangu, who was on compassionate leave, and told her she had to take accountability.

Makhura says that Mahlangu told him she saw the report but was planning to dispute its contents. “She made it clear to me that she disagrees with the report and I said I don’t know what disagreeing with the report means but the Health Ombudsman says this was very serious.”

He says that he told her the report was simply very bad and that action would have to be taken against her. “She said 'I have to resign, I’ll do so' and I was making it very clear to her that she should go that way or I’ll take a different decision if she’s not convinced.”


Mahlangu had testified earlier that she cannot carry personal blame for the Esidimeni deaths. "I cannot carry personal blame, I was not working for my personal self," Mahlangu is quoted in a Polity report as saying. "I carry the political blame simply because of the position I held at the time," she said.

The report says Mahlangu was testifying for a third day at hearings in Parktown, Johannesburg. Lilla Crouse, a Legal Aid advocate, who was seemingly not impressed with Mahlangu's answers, grilled her and asked if the closure of Life Esidimeni was ever discussed in the provincial health council meetings which she chaired. "No, it wasn't," she replied.

She also said the decision to terminate the contract was a cost containment measure, and not an executive decision. "Ever since I have been in the executive council, contractual matters have never been presented to the council…"

The report says Crouse also pressed her on whether the Life Esidimeni decision had legal consequences. But Mhlangu said: "I don't understand the question. I'm not a lawyer."

At one point Mahlangu asked to speak in Zulu in order to express herself better. An interpreter was called and she told the hearing that she found herself in a difficult situation while testifying. "The questions I am being asked are very technical and there's no politician in South Africa that can understand exactly what happens in their department. "I feel I am being constrained and I feel I am being asked questions that are beyond my role as a politician."

Some members of the crowd reacted in disbelief when she requested to speak in Zulu and one said: "She must just answer questions."

The report says Crouse also quizzed Mahlangu on claims that the move was a cost-cutting exercise. She said the process would have cost more per patient at some hospitals, which defeated the purpose. But Mahlangu, without giving a direct answer, said she did not know how much money was saved. "I'm no longer in the system," she said.

The report says Adila Hassim, the advocate representing Section27, also asked Mahlangu about the transferring of patients to Weskoppies and Sterkfontein psychiatric facilities. Hassim said it would have would have cost "six times as much" to take care of patients, defeating the point of the cost-cutting exercise. Mahlangu said the institutions were academic hospitals.


In Mahlangu's world, she's the victim – of a mysterious drone she said was hovering over her house in Johannesburg's Bedfordview, of her underlings mental health director (Makgabo Manamela), the head of department (Barney Selebano) and the project manager deceiving her and lying to her, of health ombudsman Malegapuru Makgoba's investigative report on the matter, and of having to take political responsibility for a "collective" decision.

Indeed, says a Bhekisisa report, Mahlangu's political career took priority over the lives of patients. When news of the deaths surfaced, she was "busy with political work" as head of the ANC's elections team in Gauteng, according to the health ombudsman's report on the catastrophe. The report says she has admitted she was on the ANC campaign trail for three months in 2016 while patients were dying. She said she was doing "MEC work in between". "I am a member of the ANC," she proclaimed. Long considered a rising star in the ANC, Mahlangu has built up a reputation as being a valuable and tireless worker on the campaign trail and an important fundraiser.

The report says during last year's hearings, both Selebano and Manamela painted their former boss as an MEC who would not take advice from anyone and who ruled by fear. The pressure to move patients to NGOs came from the MEC, Selebano testified. When he did raise concerns, she allegedly asked him if he was a spokesperson for Life Healthcare. Selebano said he was too scared to stand up to her. "There was no space to differ with her. Going forward, your relationship would be difficult."

Manamela, a weak witness who angered the families with rambling and conflicting accounts, refused to accept any responsibility for the tragedy. She fingered Mahlangu and Selebano, saying she merely followed her superiors' orders.

Many people told the health ombudsman that Mahlangu had said her decision was "final and non-negotiable and the project had to be done", Makgoba's report stated. And, it wasn't the first time. Reports said that that former staff members pointed to Mahlangu's oversight of the closure of tuberculosis hospitals in 2010, which had also resulted in "chaos".

Ironically, the report said, Mahlangu hasn't received overt support, at least publicly from the ANC.  Makhura was furious when the extent of the Life Esidimeni scandal became known, according to sources, not only because of the lives lost, but also because of the reputational damage to his leadership and ultimately fears that the scandal may contribute to the ANC losing power in Gauteng in 2019.

He sought to distance himself from Mahlangu and, some say, pushed her into resigning.

Makhura has repeatedly denied any knowledge of plans to move Life Esidimeni patients to community-based organisations. "I would like to state categorically that the decision to transfer Life Esidimeni mental health patients to NGOs was not made in consultation with the provincial executive council," he said in his 2017 state of the province address.

The report says since news of deaths broke in 2016, Mahlangu has maintained that the Public Finance Management and the Public Service Acts preclude MECs from becoming involved in the day-to-day management of the department. "The law is very clear what my responsibilities are. The administrative things done on a daily basis are the responsibility of the heads of departments and the managers. Of course, to the extent that (issues) impact on the patients, I have interest in that," she is quoted as saying.
She repeated this argument several times during this week's hearings.

Mahlangu's interpretation of the Public Finance Management Act is correct, says Rural Health Advocacy Project's Russel Rensburg. Under the legislation, departmental heads such as Selebano are tasked with, for instance, ensuring departments follow procurement procedures and projects are fully vetted. But Rensburg points out that, in practice, MECs have been known to take over a range of administrative functions, such as signing off on key appointments and approving budget expenditure.

The report says at the Parktown hearings, during a tea break, family members gathered in a circle on the lawn outside the tent in which the proceedings take place to pray. With their eyes closed and hands up in the air, they pleaded: "Let the truth win and the Devil be defeated. We will triumph, Devil. Lead Qedani to speaking the truth."

Their prayers are yet to be answered.


Creecy has discredited the provincial Health Department’s assertions that it terminated its contract with the Life Esidimeni group, saying there was absolutely no pressure to cut down on core services. Eyewitness News reports that Creecy is testifying at the arbitration hearings.

The department has claimed that it stopped working with the health group because of fiscal pressure, although it’s since emerged that government actually ended up spending more on mental healthcare services.

Creecy says that health is a core service and both Treasury and the Auditor-General’s office never ordered the Health Department to cut down costs towards mental healthcare.

Creecy says the department was asked to cut down on credit cards and other luxury items, but this never happened.

According to the report the Finance MEC says that each department decides on its own how much money should be allocated to various projects, and the person who is legally bound to oversee the funds is the head of department.


Precious Angels‚ the most deadly NGO in the Life Esidimeni saga‚ received R1m from Gauteng Health. In total‚ 18 patients died in two homes called Precious Angels run by owner Ethel Ncube.  The Times reports that Creecy disclosed that R47m was spent on NGOs in place of the Life Esidimeni contract. Life Esidimeni homes‚ that provided care to chronically-ill psychiatric patients‚ cost about R260m a year. The health department claimed they ended the contract to save money.

Families testified that at Precious Angels‚ patients shared spoons when eating when there was not enough cutlery. Up to eight adults were housed in a single room. The patients also did not see doctors in order to prescribe them medicine‚ it emerged at the hearings. The health ombudsman said he suspected that at Precious Angels patients likely died from cold‚ hunger and dehydration.

Ncube testified at the hearings that the health department did not pay her for patients for three months. "We did not get paid for three months. Most of the patients were on diapers. We would (use) seven bags of diapers in a day or two." She said she relied on donations from family and used savings from her stokvel groups as well as her mother’s savings to feed patients. She did not pay rent and was evicted. "I suffered‚" she said‚ also disclosing that her car was repossessed. She paid caregivers R1‚700 a month.

However‚ it emerged on Tuesday that Ncube eventually was paid a whopping R1m‚ even though Precious Angels was one of the first NGOs to be shut down due to the poor care it offered.

The report says what also emerged in Creecy's testimony is that when  Selebano and Mahlangu said they wanted to end the Esidimeni contract‚ they made no mention of using NGOs to care for patients. Instead‚ they suggested that patients be moved into state institutions.

In 2014‚ Mahlangu admitted there were not adequate facilities in the state for such chronic patients. However‚ the move went ahead in 2016 and many ill-equipped NGOs were used for patients. Creecy also testified that the health department was told when cost cutting "the level of service must not deteriorate".


The Treatment Action Campaign (TAC) will lay murder charges against Mahlangu, according to a Beeld report. TAC chair Sibongile Shabalala says Mahlangu is not taking responsibility for her role in the tragedy while testifying in the arbitration hearings. The TAC will therefore insist on criminal prosecution after the conclusion of the arbitration process.

When Hassim asked Mahlangu whether she accepted the findings of the health ombud against her in his report, Mahlangu became defensive, saying she was the one who had requested Makgoba to conduct an investigation. ‘The government has already accepted the findings,’ Mahlangu said.


And the Democratic Alliance’s (DA's) Jack Bloom is expected to open a missing persons case at the Johannesburg Central Police Station to help locate 62 Life Esidimeni patients who have still not been found, reports News24. "It is deplorable that more than 18 months since the tragedy unfolded, the Gauteng Health Department  still does not know the whereabouts of these vulnerable patients who will die without decent medical care," the party said.

"Disability grants are being collected for some of them, but we don’t know if fraud is involved and who is still alive or dead. The latest police figure is 144 confirmed deaths of former Esidimeni patients. A higher priority is needed to find all the missing patients, many of whom may already have died in terrible circumstances."

Bloom said the Gauteng Health Department had asked mental health NGOs to check if it was caring for any of the persons on a list of missing Life Esidimeni patients. He said the full names of 55 patients are listed, with ID numbers in most cases, but not all. In three cases only a first name is known, and in one, only a surname, Bloom alleged.

"There is no name at all for three of the missing patients – all that is known about them is that two are female and one is male, and their dates of birth are given," he said.

"I doubt that many of them will be traced, and they could all be dead as they would not be able to survive without decent care. This means that the true Esidimeni death toll could be more than 200 patients."

[link url=""]The Times report[/link]
[link url=""]Destiny Man report[/link]
[link url=""]Eyewitness News report[/link]
[link url=""]Polity report[/link]
[link url=""]Bhekisisa report[/link]
[link url=""]Eyewitness News report[/link]
[link url=""]The Times report[/link]
[link url=""]Beeld report (subscription needed)[/link]
[link url=""]News24 report[/link]

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