The position of MEC for Health in Gauteng is one of the most important, and probably one of the toughest public sector health jobs in South Africa. On 7 October, Gauteng Premier Panyaza Lesufi appointed Nomantu Nkomo-Ralehoko to the position, replacing Nomathemba Mokgethi, who had been in the job for less than two years.
Spotlight sent Nkomo-Ralehoko 10 questions about her plans and on the chronic problems plaguing health in the province, receiving the following responses via Tshepo Shawa, the MEC’s spokesperson.
1. After the murder of Babita Deokaran, the Department was very slow to follow up on the alleged corruption she had exposed at Tembisa Hospital. What steps will you take to ensure the corruption at that hospital is fully investigated and that justice is done?
Nkomo-Ralehoko: The Gauteng provincial government has already, through the Office of the Premier, taken action to ensure that the Special Investigating Unit (SIU) conducts a forensic investigation into the transactions at Tembisa Hospital. The Hawks are also probing the matter.
I have made a commitment that as soon as the SIU concludes the forensic investigation, we will definitely not hesitate to act on the recommendations. Sometimes, justice might seem delayed, but it is important we allow law enforcement agencies to complete their work so that firm action can be taken where there is wrongdoing.
2. From PPE-related corruption to the scandal at Tembisa Hospital, the Gauteng Department of Health appears to have a chronic and systemic problem with corruption. What steps will you take as MEC to:
i) root out corruption in the department at a systemic level;
ii) ensure there are consequences for those implicated?
Nkomo-Ralehoko: One of my immediate focus areas is to ensure the systems across delivery areas 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 with no consequence management breeds ill-discipline and a culture of ignoring processes and procedures as prescribed in our legislative framework. Our environment is highly regulated through various prescripts and it is important for oversight purposes and for good governance that the distinctive roles, in terms of the role of executive authority and the role of accounting officer, are appreciated.
I have already made an undertaking to work with stakeholders internally and externally to ensure there is accountability and consequence management. Equally so, it will be important to also recognise people who go beyond the call of duty. We need to encourage an environment where we get back to the Batho Pele principles … ensuring our work is geared towards improving patient experience of care and improving our service offering. We also need to make sure employees work in an environment that appreciates the service they render to communities and allows them to thrive.
3. The restoration of Charlotte Maxeke Johannesburg Academic Hospital was handed to the National Department of Health after the Gauteng Government botched the job. What steps will you take to ensure the hospital is fully functional again as soon as possible?
(Here, the MEC referred us to a response provided to the provincial legislature regarding the rebuilding of Charlotte Maxeke – see document at the end of the article).
4. There have been chronic management-level vacancies in the department. What steps will you take to ensure all vacancies are filled with suitably qualified people?
Nkomo-Ralehoko: Part of the intervention programme for the remainder of the sixth administration term of office will be to review the age-old organisational structure, which was last updated in 2006, to ensure it is relevant and fit-for-purpose and takes into consideration the size of the Gauteng healthcare system and the kinds of skills needed for adequate and effective care to the more than 16m people of the province, most of whom rely on the public healthcare system.
We have initiated an ambitious plan called Turning The Tide: Reclaiming the Jewel of Public Health in Gauteng, looking at a number of intervention areas. Key is the human resource component.
This is to ensure a structure that responds adequately to clinical, administrative, social and economic challenges. This will enable the department to deliver on the workforce that positively impacts its strategy execution efforts and acceptable levels of organisational performance.
5. Are you in favour of cadre deployment in the provincial Health Department?
Nkomo-Ralehoko: If by cadre deployment you mean a situation where highly trained and qualified personnel who understand the delivery imperatives of the developmental state and are committed to a high ethical standard embracing a culture and ethos of service, then indeed I am for cadre development.
However, if by cadre development you are referring to bringing incapable and unqualified people into the public service at the expense of delivery, then I can’t support such.
6. Healthcare workers often work under very difficult conditions and surveys have shown that many facilities are understaffed. What steps will you take to ensure sufficient numbers of staff are employed in Gauteng and work under decent conditions?
Nkomo-Ralehoko: Kindly refer to the response to question four above. Additional to that is that the Turning the Tide plan has also prioritised health infrastructure to ensure staff work in a safe environment.
Our department is now called the Department of Health & Wellness – on its own is a clear indication that issues of wellness will also receive special focus. We can’t preach a message of wellness while our employees are unwell and unhappy. In my first address to the staff at head office on 10 October 2022, I made a commitment that charity will begin at home. For this reason, we will soon be rolling out Wellness Wednesdays, to bring the spotlight on employee wellness and to ensure we pay more attention to the softer but critical issues that make the workplace a more conducive environment.
7. In your view, what is the key difference between the role of the MEC for health and the HoD of the province’s Health Department?
Nkomo-Ralehoko: The roles of the Executive Authority (MEC) and Accounting Officer (HoD) are clearly defined by various laws and regulations, like the Public Service Act, Public Service Regulations, and Public Finance Management Act. The executive authority is the political head and is responsible for policy direction and oversight. The executive authority delegates certain functions to the accounting officer to ensure effective public management and administration.
The accounting officer is the administrative head of the department and is responsible for the day-to-day operations of the department.
8. As MEC, will you listen to and support healthcare workers like Dr Tim de Maayer who blew the whistle when the situation at health facilities becomes untenable, or will you take steps against such people?
Nkomo-Ralehoko: I have made a commitment to staff to work with them to turn around the health system. This means that performance systems and tools must be strengthened while we also create a conducive environment allowing employees to be heard. Everyone’s voice matters if it is a voice that seeks to move us forward. We all have a role to play to restore the tarnished image of the Gauteng public health system.
9. As the province’s new MEC for Health, what lessons do you take from the Life Esidemeni tragedy?
Nkomo-Ralehoko: You will appreciate that I am just a few days in office and I am obviously getting appraised of the myriad issues confronting the system in the province. One of the commitments made was to be a patient-centred, clinician-led, and stakeholder-driven healthcare system. We intend to see this through in the remaining period of the term of office. My job is to ensure patients are at the centre of our work by giving clinicians space to do what they are trained to do while listening to the voice of the many stakeholders who want to see public health live up to its promise.
10. As we understand, you are not a medical doctor and in an SABC interview you said you are “a politician by accident”. What in your background and experience would you say makes you the right candidate for the role of MEC for Health?
Nkomo-Ralehoko: Yes, I said I am a politician by accident, given I was drawn by many lived experiences that harnessed the activist in me… driven to change things for the better. I am an administrator at heart, but also an experienced leader, having led across various structures in society.
I understand the plight of the people of Gauteng and I am committed to putting my skills and knowledge to changing things for the better. I may not be a clinician or a nurse, but I know that the healthcare system is nothing without healthcare workers.
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See more from MedicalBrief archives:
New MEC to tackle multiple crises, but lacks health credentials
Former Gauteng Health MECs told by ANC to resign from party committee
The high price medical whistle-blowers have to pay
Life Esidimeni transfers not practical, but officials forced to comply, inquest hears
ANC bigwigs score millions from Tembisa Hospital
Charlotte Maxeke fully functional only in 2026
Doctors back paediatrician’s account of Rahima Moosa collapse