In her challenging role as Superintendent-General of the Eastern Cape Health Department, Rolene Wagner has earned a reputation as a dedicated and innovative leader – qualities, say peers, that aren’t necessarily welcomed by opponents.
Yet not much appears likely to put this former competitive and capable swimmer off her stroke, writes Sean Christie for Bhekisisa, who chatted to “the boss” in some rare down-time.
Wagner calls the Eastern Cape home but the family seat, the house in which she grew up, is in Cape Town’s Lotus River.
She describes her mother, Cheryl, who devoted herself to raising three children, as “the glue holding this family together”.
Wagner’s father, Roland, died last year, after a stroke. One of the first black systems analysts in the country, he taught IT to generations of students at Cape Technikon, and also coached swimming at club, provincial and national levels.
“We all swam,” she said. “My sister Melanie and I were national record holders for years.”
A drive to succeed
Growing up, she said, education was given an almost desperate emphasis.
“Everyone assumes it was my father who pushed this, because he was the academic, but it was mom who took me to the library when I was two, ensuring that I could spend my childhood away on adventures with The Secret Seven, or The Famous Five, far from the gangs and the shooting,” she said.
She recalls being dragged by the arm between schools in the southern suburbs until one – St Augustine’s in Wynberg – offered a place.
Said Wagner: “In this house, you couldn’t do anything but be first in class, and when you were first in class, you needed to be top in your grade. And then, it was ‘Okay, where’s the school that all the top students go to in the province? That’s where you’re going.’”
Like so many spheres of life, education under apartheid was segregated, with separate systems for “whites”, “blacks” and “coloureds”. For outstanding students in the latter system, a place in Harold Cressy High School, boasting alumni like Rhoda Kadalie and Trevor Manuel, was very desirable. Wagner was accepted for her promise as a pianist.
“The standard of teaching was very high, partly because people of colour who had degrees couldn’t access other professions, so they went into education. A lot of the teachers were highly politicised.”
Derrick Naidoo, her history teacher, used to say: “‘Are you going to study medicine to make a lot of money, or are you going to make a difference?’” Wagner recalled.
She and her fellow students participated fully in the schools’ boycott of 1985 in the Western Cape, repeating the year to signify disdain for the system. For Wagner, whose life had been measured out in academic awards, the sudden rupture led her to focus more fully on swimming.
Roland Wagner was both father and coach, the roles blurring at times. But it was his great hope that his daughter Rolene would study medicine and become a doctor.
Penchant for public health
Wagner worked at the Mitchells Plain Community Health Centre, previously known as the day hospital, for three years, where her interest in public health was sparked.
“In 1996, South Africa had introduced the Choice on Termination of Pregnancy Act, but procedures were mainly available in large hospitals, and only at 12 weeks. The process required two full days, meaning parents of younger clients were bound to find out.
For many, this would have been a reason not to proceed.”
Wagner, who had been seeing patients at six to eight weeks, proposed to her superintendent that she be allowed to conduct procedures at the community health centre instead of at the hospital, where there was a long waiting list, and that she be allowed to visit all of the other day hospitals in the area, to train doctors to do what she was doing.
“You know what my superintendent said? ‘Your job is to see 45 patients a day, that’s it’. I couldn’t believe it. Anyone can see 45 patients a day. I’m talking about amplifying what we’re doing, so that many more can benefit. He couldn’t see it.”
Her frustration drove her to check newspaper classifieds, where she spotted a job in health management with the Western Cape Health Department.
“I jumped in my car and drove to the head office, only to be told that without management qualifications I stood no chance. So I drove to the University of Cape Town’s medical school, and asked if I could enrol in their newly launched public health programme. They accepted my application, and I’ve never looked back.”
Building systems is in her blood
As her training progressed, Wagner inclined towards health information systems. For her thesis she designed and rolled out a vitamin A programme, to lower the risk of death from childhood infections like measles.
Wagner is known for her use of health information systems today, not least those which she and her team implemented in East London’s Frere Hospital after she was appointed CEO in late 2012.
Frere, at the time, had a deserved reputation of being “the place where babies go to die”. Wagner set about stabilising the hospital, and a major part of her turnaround strategy, which was recognised with an award from the International Hospital Federation in 2018, was the design of an electronic patient record system, or hospital management system (HMS).
“We designed and developed it while I was at Frere but wanted to create something that would be useful more widely in the developing world,” says Wagner, who in her current role, has overseen a roll-out of an evolved version of the system, HMS2, in 40 hospitals.
As word of its efficacy spread, others have become interested: the Free State Health Department is already using HMS2 in 14 of its hospitals, and the Department of Health has asked the Council for Scientific and Industrial Research to assess the system for scalability.
Adversity
Wagner has had her share of adversity. She moved to the Eastern Cape in 1999 with her then-husband and their 10-week-old twin daughters but it wasn’t long before her marriage ended, and she was caring for the girls on her own. One of the twins, Laura, had a neural tube defect and required several lifesaving surgeries.
“It started before she was born, when every new scan revealed more things wrong with her. At a point I asked myself, ’Why are you mourning for a child who hasn’t died?’ Better to celebrate, and if something happens, deal with it then.”
Laura, now 26, is a programme manager for a thriving media company. She is also a part-time model, fashion designer and motivational speaker, telling her story of defying medical expectations, and realising goals people told her were too lofty for a person with a disability.
Emma, Laura’s sister, was admitted as an attorney in February. Wagner’s recently matriculated son, Philip, is a national water polo player.
Stabilising the system
Wagner has worked in the private sector – running a general practitioners’ practice with Medicross, and as the medical director of Netcare’s primary care division (2019-2021) – but these stints confirmed that public healthcare was the place for her.
“If a private sector facility consistently makes a loss it will be closed, but we don’t have that mandate. We must still provide the services, and must do so in the context of shrinking budgets. To do this we have to be social entrepreneurs, and that’s what I love about the space we’re in. It’s about building social capital through the work we do.”
The position of Superintendent-General of the Eastern Cape Health Department was advertised in the middle of the Covid-19 pandemic.
Wagner, who was working in Johannesburg with Netcare, “took a leap of faith” and applied. After being appointed, she took control of a department on the verge of collapse.
“The first six months were all about stabilising the organisation,” she said. Budgets were reprioritised, and controls implemented, including a roll-out of HMS2. By the end of 2022/23 there was some measurable improvement: irregular expenditure, which had been at R156.5m in 2020/21, was down to R6.8m.
The department’s steeply rising debt trajectory had levelled off, and, thanks to precedent set by a February 2023 ruling in the Eastern Cape High Court, the department’s medico-legal bill dropped by 65% between 2017-18 and 2023-24.
Judge Robert Griffiths ruled that the common law must be developed so that the state would not have to pay the future medical expenses of patients harmed through negligence as a lump sum, instead offering treatment in state facilities.
“That judgment is now being tested at the Supreme Court of Appeal, and if it is upheld, it won’t just benefit us in the Eastern Cape, it will be the entire health sector to which the law will apply. Winner!” said Wagner. “And then I left.”
In a move that scandalised the public healthcare community, Wagner was shuffled into the Office of the Premier by Eastern Cape Premier Oscar Mabuyane.
She was one of four heads of departments removed from office in this way, in murky circumstances.
In an article in Spotlight, Alex van den Heever, chair of social security systems administration and management studies at the Wits School of Governance, was quoted as saying: “To me, it sounds like they removed the accounting officer and replaced them with an acting person to manipulate contracts, tenders, procurements, and appointments,” a widely-held theory in the medical community, at the time.
Wagner was returned to her role in August 2024. It would be impolitic for her to dwell on the fiasco, and she doesn’t – saying, instead, that the workings of life are mysterious.
Finding balance in a binary life
“In that year my father had a stroke, my mother had serious health issues and my kids needed some extra support. Thanks to what happened, I was able to be there for them,” she said. There was also time for introspection.
“After my father died I realised I had been leading a binary existence for years, with family on the one side, work on the other, and nothing in between. Among other things, I had been completely ignoring my own risk factors.”
Wagner – a university track star – hauled out a treadmill she had used four times in four years, and started running fartleks over a distance of three kilometres. She watched what she ate and dropped 8kg.
Wagner will need every iota of renewed energy to arrest the department’s slide into dysfunction. Departmental debt ballooned in her absence.
Every week brings its own clutch of negative headlines, and belief in Wagner’s ability to turn things around has undoubtedly waned.
Ben Gaunt, the former CEO of Zithulele Hospital (and no longer an employee of the provincial Health Department, after he applied successfully for constructive dismissal) said: “There’s no question she’s the right person for the job. She has the rare ability to see both the bigger picture and work in the grain of short term solutions – but she works in a very unconstructive environment, where truly strong leaders aren’t necessarily welcome.”
See more from MedicalBrief archives:
Relief as Rolene Wagner returns to hot seat
Top health experts rally behind ousted Eastern Cape Health boss
Corruption-busting Eastern Cape Health HoD sidelined by premier
Eastern Cape ruling could change how medico-legal claims are settled