A group of doctors and activists has launched a campaign and signed a petition demanding the reinstatement of Eastern Cape Health HoD Rolene Wagner, who was redeployed to the Office of the Premier this month for what her supporters call a “wishy washy reason”, and which, they say, will have a devastating impact on the ailing sector in the province.
The 129 petitioners and other health professionals say there is no valid reason for the decision, and that Eastern Cape Premier Oscar Mabuyane’s decision to second the heads of several provincial departments to a Project Support Unit in his office is “political”.
As reported in MedicalBrief, high-performer Dr Rolene Wagner, head of health since 2021, has been credited with turning around the beleaguered department. She has been credited with improving efficiencies, scaling back unauthorised spending, and overseeing the roll-out of a digital health record system to 26 hospitals and three Emergency Medical Service units, which saves the department around R45m annually, writes Luvuyo Mehlwana for Spotlight.
However, in his announcement, Mabuyane said the new “crack team” would focus on scaling up “the implementation of government commitments in … areas identified as lagging in our monitoring and evaluation processes”, flagging, among others, investment co-ordination, support to local government, and driving education and health turnaround strategies.
But his decision to include Wagner among those on his hand-picked unit has been roundly condemned, with the Progressive Health Forum saying this would “compromise the improvement of the health system in the Eastern Cape”.
Others have suggested that replacing valued people with acting appointees was intended to make it easier to “manipulate contracts, tenders, procurements and appointments”.
They called the decision political, saying Mabuyane was “panicking” before the national and provincial elections next year.
Justification
Mabuyane has said “there is not going to be any vacuum or negative effect on service delivery in the departments they are coming from because they have set sound systems in place”.
He said for purposes of “continuity in the management of operations in departments”, he had appointed acting HoDs.
In Wagner’s case, CFO Msulwa Daca is to act as HoD, but the division of responsibilities remains unclear.
The letter sent to Mabuyane in a “Bring Back Wagner campaign” has asked him to reconsider her removal.
The action came after some media reported she had been removed based on alleged underperformance relating to the department’s failure to fill more than 1 000 critical vacant posts, including those of nine CEOs at Frere, Nelson Mandela Academic, Livingstone, Dora Nginza, Jose Pearson, St Elizabeth, Fort England, Tower and Komani Psychiatric hospitals.
The signatories of the petition expressed their concern over her redeployment after a period that was first reported as leave, then as a suspension, and later, in Mabuyane’s statement, as a move to the Project Support Unit in his office.
The letter-writers said the “turnaround already evident under Wagner’s leadership is remarkable and deserves and requires sustained support and commitment from all stakeholders”.
“We contend it is impossible for one person to ‘resolve all the complexities’ of the Eastern Cape health system, accumulated over decades, in just two years.”
They wrote that her achievements “include the successful court battle that curtailed the haemorrhage of funds lost to medico-legal settlements (an estimated total of around R1.5bn further loss has thereby been averted)”.
She also eliminated unauthorised expenditure of the budget vote and reduced irregular expenditure from around R200m in 2020/21 to under R6.7m by the end of the 2022/23 financial year, they pointed out.
On 3 October, Mabuyane “clarified” the situation, stating that Wagner and the three other HoDs, along with other selected officials would, from 1 October, be part of the team in the special unit, to be led by the Director-General.
“We have entered into secondment agreements with the officials and their respective departments for 12 months because the tasks we are assigning them are matters of provincial importance,” he wrote.
It is not clear if this means that Wagner will, after the 12 months “secondment”, be reinstated in her post as head of health in the province.
Blowback
A former employee of the national Department of Health, Dr Tim Wilson, who supports the “Bring Back Wagner campaign”, told Spotlight he was very concerned about the instability her removal created, in a department already beset by many challenges.
While Wagner has chalked up a series of successes since her appointment in August 2021, the provincial health sector has been stumbling from crisis to crisis, mostly due to the department’s dismal financial situation.
It is swamped with “runaway accruals” – money owed to service providers from the previous financial year. Earlier this year, this amount stood at R4.76bn – roughly 17% of the department’s R28b budget.
This dire state of affairs was inherited by Wagner, reports Daily Maverick.
Desperate department officials have been constantly putting out fires as service providers suspend services, leading to drug stock-outs and long waiting times for orthopaedic services due to a shortage of devices.
Some officials say they “live in hope” that their power will not be cut as administrators must choose between paying for medical services or paying their municipal accounts.
Employees’ compensation takes up 81% of the remaining budget, and for years, the spending of millions on a “bloated administration” has been slammed by opposition parties – and ignored by the provincial government.
Last month, the Office of the Premier flagged the vacancy crisis in the department, where more than 1 000 posts remain unfilled. These include nine CEO posts and several senior administrative positions.
Key hospitals in the province remain without permanent CEOs, while senior administrative positions in governance departments also remain vacant.
After a recent oversight visit of the provincial Health Committee, the DA’s Jane Cowley asked Health Minister Joe Paahla to immediately place the province’s Health Department under administration.
Phaahla visited the province two days later and said it was “too early” to do so.
The department has faced a real crisis for some time as its R49n debt to oxygen and gas supplier Afrox is putting patients at risk. Several smaller payments have been made to the service provider, but the debt is growing.
it is, in fact, technically bankrupt.
Yet removing Wagner was likely to set back the department even further, said critics.
“It is very disruptive,” said Wilson. ”People always comment on how the health service in the Western Cape is functioning. One of the key issues is that the Western Cape since 1994, has had limited HoDs despite different governing parties.
“But in the Eastern Cape, I don’t know how many HoDs have been there – it seems there is no understanding of how complex it is to lead such a large organisation.”
Wilson said that it was highly likely that after the election, there would probably be a new MEC for Health.
“This means he or she will want to appoint a new HoD, leading to more disruption. For ordinary doctors and nurses working at district level, it is very disruptive to have a change in management.”
It is reported that Wagner failed to fill vacant posts, said Wilson, “but thousands of positions have been filled since her appointment and she has saved money for the department”.
“The lack of funds has been a problem in the Eastern Cape Health Department for years.”
Dr Aslam Dasoo, convener of the Progressive Health Forum, told Spotlight: “Wagner’s appointment was welcomed by the entire healthcare system as the Eastern Cape was among the worst-performing provinces in the country. With her leadership and hard work, she has shown herself to be a competent and hardworking public servant.
“It is wishy-washy that she has been seconded to the Project Support Unit, in the Office of the Premier… a poor decision.”
‘No valid reason’
Professor Alex van den Heever, the chair of Social Security Systems Administration and Management Studies at the Wits School of Governance, said Mabuyane was trying “to shed a positive light on what is effectively a removal of accounting officers from four departments”. (HoDs are the accounting officers for their departments.)
“However, there is no valid reason for doing so and the creation of the Provincial Crack Team seems nonsensical. You do not remove a key leader from a major department that is involved in billions of rands of procurement … it sounds like they removed the accounting officer and replaced them with an acting person to manipulate contracts, tenders, procurements, and appointments,” he said.
He also questioned the legality of this move. “I’m not sure they can just be shoved aside like this or that this whole move to some special project is proper. They’re designated as accounting officers. All of it looks extremely improper and concerning and clearly not in the public interest.”
Dr Beth Engelbrecht, former HoD of the Western Cape Department of Health said: “The relationship of the Project Support Unit with MECs and HoDs of departments is unclear, and confusing accountability and governance lines and arrangements. The much-needed stability to manage the most complex department (Health) in a province is derailed.
“It is concerning that we have a very competent manager with a proven track record tasked with turning around the department in a systematic way. Research has shown that stability in senior leadership is a determining factor for success and for deepening leadership capacity.”
She said there would be lots of uncertainties about initiatives already under way, among these the turnaround strategy started by Wagner, while the Project Support Unit seems to be tasked largely with longstanding systemic matters that cannot be resolved in the 12 months of their tenure.
“So, there may be a lot of unintended consequences,” she told Spotlight.
Insiders have suggested the decision to move Wagner could be seen as an attempt by Mabuyane to create the impression that he’s cleaning up his government ahead of the 2024 elections.
A recent damning report on the state of governance inside the department was issued by the Auditor-General, its findings including a material irregularity that was flagged because of a failing patient record management system.
The department has also failed to meet targets to reduce neonatal and maternal deaths in its facilities.
“Record-keeping (remains) an issue at health for medical records. This has (an) impact on the department (that is) unable to defend itself on medical litigations. Team is assessing a possible harm to the institution and a material irregularity on unavailability of medical records,” said the Auditor-General.
The AG’s report also flagged the Eastern Cape Health Department for failing to reach its target of at least 26% of clinics passing the ideal clinic standard. Only 21% of clinics (153 out of 733) are conforming to this standard.
‘Turnaround was already evident’ under Wagner
In their letter, the public health advocates, academics and doctors implored Mabuyane to allow Wagner to continue to implement her plans for the department.
They wrote that she was respected in the public health community for her leadership of health systems-strengthening and turnaround.
“The inability to fill these posts, however, links to funding limitations that have made appointments impossible. These vacancies pale in light of the fact that, as recently reported at the Rural Health Conference, more than 13 500 healthcare workers were appointed in 2022, placing them at rural facilities and other priority sites.
“And between April and July 2023 alone, it more than 9 000 appointments were made, 1 390 being permanent employees, and 7 647 contract appointments.
“These figures illustrate the magnitude of the task Dr Wagner and her team have had to address since her appointment in August 2021, at the height of the pandemic.
“Destabilising Eastern Cape health leadership, which has achieved remarkable successes in a relatively short time, will endanger these and future achievements, undermine staff morale, and directly contribute to deteriorating levels of service delivery.
The Rural Health Alliance has added its support, asking the premier to reverse the decision and saying any decision to remove Wagner from her position would have a detrimental effect on the roll-out of health services, while chairperson of the Rural Doctors Association of South Africa, Dr Lungile Hobe, said: “Dr Rolene Wagner is not the problem. The Eastern Cape has systemic challenges that need systemic solutions.
“To get a turnaround … we need continuity rather than changing management.”
Mixed feelings
Other stakeholders have mixed feelings. The Treatment Action Campaign’s (TAC) general secretary, Anele Yawa, questioned the interventions made by Wagner to change the department.
“As TAC and Ritshidze, we have mixed feelings since we have tried on numerous occasions to meet her, where we wanted to reason with her. We wanted to discuss issues of infrastructure, human resources, quality of services, availability of medicine, and all other challenges the Eastern Cape is confronted with,” he said.
People claim to be serving the people, but when structures representing the people reach out to them, they are nowhere to be found, added Yawa.
“We are aware of Wagner’s intervention in turning around the situation in the province … reducing funds lost to medico-legal settlements. But we are not sure about other interventions, which makes it difficult for us say it was wrong or right for the Premier to remove her.”
Spotlight article – Mabuyane under fire for moving Eastern Cape head of health
See more from MedicalBrief archives:
Corruption-busting Eastern Cape Health HoD sidelined by premier
Eastern Cape Health boss under fire in ‘political clean-out’
DA: New superintendent-general is qualified but Eastern Cape Health is a sinking ship
Eastern Cape ruling could change how medico-legal claims are settled