Eleven registrars in 11 years with Dr Magome Masike becoming the latest to take up the hot seat at the troubled Health Professions Council. He does not shy away from this embarrassing track record as he cites the number.
Masike is a qualified doctor turned businessman and ANC politician. Previously, he served as mayor of Klerksdorp (now Matlosana City Council) and went on to be MEC for Health in the North West province between 2010 and 2018. He was axed when Job Mokgoro became premier.
'Things have gone wrong'
Masike comes to the HPCSA after high drama in 2021 when then-CEO Dr David Motau - two months into his term - was put on precautionary suspension pending an investigation into allegations of misconduct. In March 2022 Motau failed in his High Court bid to have his suspension at the HPCSA overturned. As Spotlight previously reported, Motau was facing charges of contravening sections of the Public Finance Management Act in a case relating to alleged corrupt payments amounting to R8.7m during his time as head of department in the Free State Department of Health.
Since Motau's exit from the role, Melissa De Graaff followed by Dr Thabo Pinkoane have served as acting CEO and registrar.
The HPCSA, as a statutory body, is meant to raise and uphold standards and ethics in the health professions to assure and protect public healthcare users that health services in the country meet a set standard. 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 admits to Spotlight that there is deepening public distrust and loss of confidence and he acknowledges that these are clear symptoms of things having gone wrong for the council.
For over a decade at least the HPCSA has been routinely exposed for poor governance, mismanagement, and administrative irregularities. As Spotlight previously reported, issues of conflicts of interest keep rearing its head, as do 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 ministerial task team investigation in 2015 laid bare a raft of irregularities and challenges at the institution and made several recommendations to get the council's house in order. The investigation team's findings included that senior staff in the HPCSA were unfit to hold their positions; there was widespread misconduct; irregular expenditure; and failure to efficiently manage operations. The institution has also been subjected to various investigations by the Special Investigating Unit (SIU). One SIU investigation from 2019, for example, led to precautionary suspensions in 2021 of several officials implicated in bribery allegations in registration processes.
More recently, in June, another SIU report was presented to Masike. Ahead of these findings being made public Masike told Spotlight the presentation "is not the best news for us". He acknowledges that "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 the HPCSA president Professor Simon Nemutandani relating to allegations over what the union says are irregular remuneration approvals. Masike says clarity around activities that qualify for remuneration is needed.
'Not a popularity contest'
Seated in his Pretoria office for the interview, Masike began with dismissing suggestions that his appointment to the five-year term is a mere political posting and simply to see out his last working years before retirement. Masike is a father of three grown children with his wife Masomo, who is a physiotherapist.
"This is not a job that is about a popularity contest and I also don't intend on going anywhere before my time is up," he says.
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 the son of two mining trade unionists and says that is how his activism took root. Masike 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, who spoke to Spotlight, have complaints 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 the council is out of touch with on-the-ground realities and makes unilateral decisions around the likes of training for doctors without a realistic assessment of demand and supply or efficient time allocations for different training modules.
Dr Angelique Coetzee, the former chairperson of the South African Medical Association, has been a critic of the slow rate of change at the HPCSA. She is especially scathing about delays in acting on recommendations for organisational review and an overhaul of governance and administrative structures following the 2015 ministerial review. She also says the HPCSA continues to fail in effective communication to the public and practitioners.
She says Masike's political allegiances to the ANC and his exit from his MEC role "will always be a cloud and raise questions about what transpired".
Coetzee adds, "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 turmoil that the healthcare sector is in and being a member of the ANC could undermine Masike's authority in the role."
Dr Aslam Dasoo from the Progressive Health Forum raises similar questions around independence. He also flags the weakening separation between executive and administrative functions at the council.
"Regulatory bodies, particularly in the health sector, seem to have been compromised by incompetence and corruption so their mandates are blunted and their objectives are misdirected resulting in very poor regulatory oversight," he says.
Dasoo says the call to disaggregate the medical and dental professions board from the other 11 health professions continues because this board is seen as subsidising the other professional boards but members say is not receiving the necessary administrative attention. "It has proved to be quite disastrous", he says.
The Competition Commission's Health Market Inquiry in 2019 also blasted the HPCSA for not being flexible and innovative enough in particular around fee-sharing and subcontracting - a block to transforming the landscape that would allow for more competition and bring down healthcare costs.
Added to this are ongoing complaints from the public that negligence and malpractice cases against health professionals remain unresolved. The Women's Legal Centre, for example, publicly slammed the HPSCA, writing in a Daily Maverick article that "very little has changed at the HPCSA" since the ministerial task team investigation in 2015.
Masike believes the turnaround will come with organisational change focused on creating internal stability. "The HPCSA has to have 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 have to have the right people doing the right job and our finances have to be right," he says.
"We also have to act within policies - regardless of who you are or what country you are coming from, or what seniority you have. We act within the constitution of the country - that's why we might not always be popular with our members," he says.
The HPCSA this month continues its high-profile inquiry against North West Health MEC Dr Phophi Ramathuba relating to her conduct and treatment of a patient in a Limpopo hospital in August 2022.
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.
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"I have committed myself that the turnaround time should be five days - from the time you put your paperwork in to when you are back on the register," he says as he gets up from his seat to show the view from one of his office windows. It overlooks the walk-in office. There are people slowly shifting up rows of chairs to get their paperwork filed or to make a complaint.
The registration of doctors with foreign qualifications also needs to be sped up, he admits. The registration of foreign-trained doctors has fuelled allegations of an uneven hand 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 the likes of much-needed specialists. His target for the council is that a decision should be made within 30 days.
Masike says he recognises that the HPCSA needs to be adaptive, saying, "Policy must serve us. We are not here to serve policy." He adds that artificial intelligence and robotics are changing medicine, so new rules are needed. The same for regulations as traditional academic pathways are being changed with the likes of private medical schools popping up around the world.
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 says.
Masike has a timeframe that by year-end he must have proven that his are the capable hands needed to steer the HPCSA onto 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, and a whole lot of it, if the council is to have any hope of meaningful change.
