There are multiple challenges ahead – again – for Nomantu Nkomo-Ralehoko, who has been reappointed as Gauteng’s MEC for Health & Wellness, and who, say some critics, did not do justice to the role or her mandate in her previous reign.
Nomantu Nkomo-Ralehoko’s first appointment to the job was in October 2022, after having previously been MEC for Finance & e-Government and a member of the provincial legislature since 1999.
She returns to the critical role as the provincial Health Department remains mired in a chronic cycle of administrative and service delivery dysfunction, writes Ufrieda Ho for Spotlight.
At just under R65bn for the current financial year, the department gets a massive slice of the Gauteng budget. While the National Department of Health leads on health policy, the day-to-day running of public healthcare services is managed by provincial Departments of Health.
Gauteng Health has numerous vacancies. On the administrative side this includes the critical position of a chief financial officer (CFO). Previous CFO Lerato Madyo was suspended in August 2022, and her case is still to be concluded.
Madyo’s case is connected to ongoing investigations by the SIU into corruption at Tembisa Hospital.
When Nkomo-Ralehoko answered 10 questions from Spotlight shortly after her appointment in 2022, she said: “One of my immediate focus areas is to ensure that the department’s systems … such as Finance, Human Resources, Monitoring and Evaluation, Risk Management, etc. are strengthened so that processes are not dependent on human vulnerability but there are clear checks and balances. An environment that has no consequence management breeds ill-discipline and a culture of ignoring processes and procedures as prescribed in our legislative framework.”
Gauteng also faces mounting surgery and oncology treatment backlogs. Its clunky supply chains and procurement systems have often left suppliers unpaid and facilities struggling without basic medical consumables as well as not being able to procure large pieces of equipment when needed.
Some hospitals have had periods when patients have gone without food.
Questions remain about governance capacity in the department. Notable examples from Nkomo-Ralehoko’s tenure so far include inaction over utilising a March 2023 Gauteng Treasury allocation of R784m for outsourcing radiation oncology services. These ring-fenced funds were secured after sustained pressure and protests by activists and civil society.
To date, this money has still not been spent.
The department is also still to implement a June 2022 memorandum of agreement with the University of Witwatersrand. The agreement sets a framework for the department and the university to mutually address many of the health sector challenges in the province, while ensuring the academic training of the next generation of doctors takes place.
Another key challenge for Nkomo-Ralehoko will be how to navigate a changed Gauteng provincial legislature in this seventh administration. There is no outright majority and no unity government deal that includes the largest opposition party, the DA. This will represent distinct hurdles for passing budgets or garnering enough votes for approvals in the house.
Despite these challenges, the reappointment of Nkomo-Ralehoko is being welcomed by some, who say she brings stability to a portfolio that has been plagued by shaky, short-lived tenures in the top role.
They say she has a flexible leadership style, and that she is open to working with many different stakeholders.
But her critics charge that she cannot deliver the overhaul that the department needs and has not been tough enough on corruption.
‘More of the same’
Gauteng’s DA shadow minister for health Jack Bloom says: “I don’t think she deserves to be reappointed, but that’s for the ruling party to determine. What we will get going forward is more of the same. The department needs wholesale change but it’s not going to happen under the present situation.”
Bloom says Nkomo-Ralehoko’s comeback is “cadre deployment and political protection”. “I’m afraid the corruption is across the board and the looting is going to continue.”
He says the MEC slow-walked disciplinary action on many suspended senior staff and has also failed to tighten up on pre-employment checks on potential employees, resulting, he says, in weak candidates being appointed.
‘Delays that cost lives’
Speaking briefly to eNCA after signing her oath of office on 3 July, Nkomo-Ralehoko mentioned oncology and radiation services as one of her priority areas.
She referred specifically to the building of bunker-like facilities to house specialist cancer treatment equipment procured for Chris Hani Baragwanath Hospital and George Mukhari Hospital.
However, for Salome Meyer of the Cancer Alliance, the fact that equipment has been procured but is sitting in storage amounts to delays that cost lives: there are 3 000 patients in the province on waiting lists for cancer treatment.
“We’re seeing resignation after resignation from radiation therapists because they aren’t on the correct pay grade. So even when we do get equipment we don’t have enough people to operate it.
“The MEC has to start looking after her own people – the people who work in our clinics and hospitals,” she says.
‘
Ensuring stability’
The Democratic Nursing Organisation of South Africa (Denosa) in Gauteng says Nkomo-Ralehoko has used her 20 months in the MEC role so far to start making the right turnarounds for the Health Department.
Bongani Mazibuko of the nursing association says: “This welcome appointment of the MEC will go a long way in ensuring stability in the department”.
Lack of stability has been a feature of Gauteng Health over the past decade or so. When Nkomo-Ralehoko was appointed in 2022, she replaced Nomathemba Mokgethi, who had been in the job for less than two years. Before that, Bandile Masuku was also in the position for under two years. Gwen Ramokgopa filled in for a bit more than two years, and before her, Qedani Mahlangu was forced to resign after the Life Esidemeni tragedy.
Denosa also called for the finalisation of CEO appointments and for senior management posts to be filled, adding that fixing of infrastructure was also critical “so that the department can be more functional”.
Right direction, but act on corruption
Treatment Action Campaign Gauteng chairperson Monwabisi Mbasa, who also supports Nkomo-Ralehoko’s reappointment, says that in comparison to her predecessors, Nkomo-Ralehoko has been someone with whom they feel they can work.
“In the past nearly two years, the MEC has tried to address some issues at provincial, district and clinic level. She is hands-on and flexible, so we have confidence in her.”
But Mbasa says the MEC must be held to account for “not taking drastic action against corruption”.
He says 26 of Gauteng’s 37 public hospitals had run out of food, but Nkomo-Ralehoko’s intervention included using suppliers and service providers who were not properly registered. He called this a red flag and they would continue to hold her to account.
Also vital, Mbasa says, is alignment of the Health Department with the Departments of Infrastructure & Development and of Finance.
“This is an emergency. We are also calling for the improvement of supply chain management and procurement of goods and services, and we need to improve human resources.”
See more from MedicalBrief archives:
Activists march for unused R784m to be spent on cancer patients
Construction and IT companies among ‘food suppliers’ to Gauteng Health
The long, slow collapse of South Africa’s top hospitals