The track record of registrars at the troubled Health Professions Council of South Africa is embarrassing – 11 registrars in 11 years – admits Dr Magome Masike, the latest to take up the hot seat, and who is promising transparency and accountability from the council in the future, writes Ulfrieda Ho in Spotlight.
Masike, a doctor turned businessman and ANC politician, previously served as mayor of Klerksdorp before becoming MEC for Health in the North West Province between 2010 and 2018.
His appointment to the HPCSA comes after drama in 2021 when then-CEO Dr David Motau – two months into his term – was put on precautionary suspension pending an investigation into misconduct allegations.
In March 2022, Motau failed in his High Court bid to have his suspension overturned. He was facing charges of contravening sections of the Public Finance Management Act in a case relating to alleged corrupt payments amounting to R8.7m while he was HoD at the Free State Department of Health.
Since Motau’s exit, Melissa De Graaff, followed by Dr Thabo Pinkoane, have served as acting CEO and registrar.
The HPCSA oversees 12 professional boards and is mandated under the Health Act to direct the education, training and registration of practising health professionals.
Masike admitted to Spotlight that there was deepening public distrust and loss of confidence in the council, acknowledging these are clear symptoms of things having gone wrong.
For at least a decade, the HPCSA has been routinely exposed for poor governance, mismanagement, and administrative irregularities. Conflict has been a constant, as have the unsettled issues of the possibility of unbundling boards from the Council and the need for a clearer delineation of functions between its internal structures.
A 2015 ministerial task team investigation exposed numerous irregularities and challenges and made several recommendations to get the council’s house in order. The findings included that senior staff were unfit to hold their positions; there was widespread misconduct; irregular expenditure; and failure to efficiently manage operations.
It has also been probed by the Special Investigating Unit (SIU). One investigation from 2019, for example, led to precautionary suspensions in 2021 of several officials implicated in bribery allegations in registration processes.
Last month, another SIU report was presented to Masike, who said “evidence-based” findings against the HPCSA cannot be ignored.
Also in June, Nehawu (National Education, Health and Allied Workers Union) wrote to Parliament calling for action against HPCSA board members and its president Professor Simon Nemutandani regarding allegations over what the union says are irregular remuneration approvals.
Masike said clarity around activities that qualify for remuneration was needed.
‘Not a popularity contest’
He dismissed suggestions that his appointment to the five-year term was a mere political posting and simply to see out his last working years before retirement.
Masike and his wife Masomo, a physiotherapist, have three adult children.
“This job is not a popularity contest and I also don’t intend going anywhere before my time is up,” he said.
Masike is credited, during his time as Health MEC in the North West, for merging Tshepong and Klerksdorp Hospitals when the two institutions were split along racial lines and marked by unequal services for the community.
He grew up as the son of two mining trade unionists, which he said was how his activism took root. He also has a background in designing continued professional development programmes in the health sector and had a business development role at computer technology company Oracle. He is currently pursuing a PhD in public health.
Management issues
Various HPCSA members have complained to Spotlight about drawn-out registration processes and clunky administrative systems that need to be completed for continued professional development points.
For many, the institution has fading relevance beyond issuing a practice number and collecting subscriptions. There is also criticism that it’s out of touch with realities and makes unilateral decisions around training for doctors without a realistic assessment of demand and supply or efficient time allocations for different training modules.
Dr Angelique Coetzee, former chairperson of the South African Medical Association, has been a critic of the HPCSA’s slow rate of change, and especially scathing about delays in acting on recommendations for organisational review and an overhaul of governance and administrative structures after the 2015 ministerial review.
She said Masike’s political allegiances to the ANC and his exit from his MEC role “will always be a cloud and raise questions”.
“We need openness and transparency. We need to stop cadre deployment, and appointments to government structures must be on the basis of meritocracy. We need strong leadership, especially in the current healthcare sector turmoil, and being a member of the ANC could undermine Masike’s authority in the role.”
The Competition Commission’s Health Market Inquiry in 2019 also blasted the HPCSA for not being flexible and innovative enough around fee-sharing and subcontracting – a block to transforming the landscape that would allow for more competition and slash healthcare costs.
Added to this are ongoing complaints from the public that negligence and malpractice cases against health professionals remain unresolved.
Masike believes the turnaround will come with organisational change focused on creating internal stability.
“The HPCSA needs an internal managerial system that works for us to have (an) impact on society. An incompetent organisation that is not managed properly cannot have an impact on society. So we must have the right people doing the right job and our finances must be right,” he said.
Faster turnaround times for complaints
Masike’s hope for modernising the council lies in digitisation, integrated information systems, and trained personnel who can use these new technologies effectively to improve turnaround times for complaints handling and registrations.
“I have committed myself that the turnaround time should be five days – from when you put in your paperwork to when you are back on the register.”
The registration of doctors with foreign qualifications also needed to be expedited, he admitted, the issue having fuelled allegations of uneven handling in how the HPCSA recognises qualifications from different parts of the world.
The call is for more transparency in how decisions are made and a reckoning that registration red tape costs the country in terms of, for instance, much-needed specialists.
His target for the council is that a decision is made within 30 days.
The HPCSA also needed to be adaptive, he added. “Policy must serve us. We are not here to serve policy.”
“Artificial intelligence and robotics are changing medicine, so new rules are needed.”
It is a balancing act of numbers, maintaining quality and standards of professionals, and matching changing needs. This will come into play as the NHI (National Health Insurance) moves towards implementation, he said.
His timeframe is that by year-end he must have proven that his are the capable hands needed to steer the HPCSA on to a better path. He’s chosen an open-door policy, he says.
He also wants to get stuck in, even if it’s “going downstairs and kicking some butts into action”. It’s a joke, but it’s also a reality. His feet will need to get busy with kicking, if the council has any hope of meaningful change.
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