This week, several healthcare stakeholders have slammed Eastern Cape Premier Oscar Mabuyane's announcement that the heads of several provincial departments have been seconded to serve on a Project Support Unit in his office. This unit, Mabuyane said in a statement will focus on scaling up "the implementation of government commitments in the critical areas we have identified as lagging in our monitoring and evaluation processes". He then flagged these critical areas as, among others, investment coordination, support to local government, and driving education and health turnaround strategies.
Among the HoDs he removed from their positions to serve on this unit, also dubbed the "Crack Team" is Dr Rolene Wagner, who was appointed as head of the province's health department in 2021. Earlier this year Spotlight published an in-depth article assessing Wagner's performance in the HoD position.
Some health activists and professionals, including the Progressive Health Forum (an advocacy group of mostly healthcare workers), however, said Mabuyane's decision is "compromising the improvement of the health system in the Eastern Cape". Some political commentators were quoted in the Daily Dispatch as having said it is politics with Mabuyane "panicking" before the national and provincial elections next year.
Mabuyane, however, in his statement this week insisted that "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 appointed acting HoDs.
The timeline
On 19 September, the deputy director for human resources and corporate affairs in the provincial health department in a notice informed health workers, district managers, and other senior officials in the provincial health department that Wagner "has been granted leave of absence from 18 to 30 September 2023". The CFO, Msulwa Daca, would act as HoD during this period.
"Mr Daca will be expected to exercise all the duties and responsibilities associated with the position of the head of the department, which includes adherence to the provisions of all the relevant prescripts and legislation, including, but not limited to, the PSA (Public Service Act), PFMA (Public Finance Management Act), NHA (National Health Act), etc.," the notice read.
On 29 September, health activists and professionals in a "Bring Back Wagner campaign" sent a letter to Mabuyane asking him to reconsider Wagner's removal. This followed media reports in the Daily Dispatch that the premier removed her 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 129 signatories of the letter expressed their dismay and concern over Wagner's removal, which was first reported as leave, then reportedly a suspension, and later amid the outcry - Mabuyane's statement that Wagner had been removed from her position to form part of the Project Support Unit in his office.
In defence of Wagner, the health activists and professionals in the letter stated that the "turnaround already evident under Wagner's leadership is remarkable and deserves and requires sustained support and commitment from all stakeholders". "We contend that it is indeed 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 widely reported successful court battle that curtailed the haemorrhage of funds lost to medico-legal settlements (an estimated total of around R1.5 billion further loss has thereby been averted). Additionally, she oversaw the roll-out of a digital health record system to 26 hospitals and three Emergency Medical Service units, which saves the department around R45 million annually. She also eliminated unauthorised expenditure of the budget vote and reduced irregular expenditure from around R200 million in 2020/21 to under R6.7 million by the end of the 2022/23 financial year."
On 3 October, Mabuyane 'clarified' the situation stating that Wagner and the three other HoDs, along with other selected officials will, with effect from the 1st of October 2023, be part of the team in this unit that will be led by the Director-General. "We have entered into secondment agreements with the officials and their respective departments for a period of 12 months because the tasks we are assigning them are matters of provincial importance." 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 is very concerned about the instability this creates in a department already beset by many challenges.
"The instability of leadership is very problematic in the health service and it is very disruptive. 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 while they had different governing parties. In the Eastern Cape, I don't know how many HoDs have been there and it seems that there is no understanding of how complex it is to lead such a large organisation (a provincial department of health)."
Wilson said, that in a few months' time - after the election - it is highly likely that there will be a new MEC for Health. "This means the new MEC will want to appoint a new HoD, which will lead to more disruption. For ordinary doctors and nurses working at the district level, it is very disruptive to have a change in management. Constant changes in leadership in the health sector are very disruptive, even for policy-making."
It is reported that she failed to fill vacant posts, said Wilson, "but thousands of appointments have been made 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, convenor 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." Dasoo said the fact that she was removed from that office without any explanation is depressing. "We believe that it is wishy-washy that she has been seconded to the Project Support Unit, which will be based in the Office of the Premier. This action is going to compromise the improvement of the health system in the Eastern Cape. It was a poor decision and the Premier must reinstate Wagner and the other HoDs to their positions and allow them to continue with all their powers and responsibilities as stated in their initial appointment letters," said Dasoo.
'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 is now 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. To me, it sounds like they removed the accounting officer and replaced them with an acting person to manipulate contracts, tenders, procurements, and appointments," he said.
Van den Heever said that accounting officers are responsible for decisions and they will be held accountable if the budget is used for improper procurements. "it's their head on the block." He also questioned the legality of this move. "So, I'm not sure from a legal perspective if these people will remain the HoDs of their respective departments, meaning that they remain the accounting officers. I'm not sure that they can just be shoved aside like this - that this whole move to some special project is proper. They're designated as accounting officers. All of it," van den Heever said, "looks extremely improper and it is concerning and most clearly not in the public interest."
Also reflecting on the situation, 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."
According to Engelbrecht, the director general of the province has the authority in the Office of the Premier, so these HoDs and senior officials who were removed from their line function authority no longer have leverage or authority over their line departments.
HoDs often serve on various committees, including committees established by provincial cabinets, said Engelbrecht. In such cases, however, the HoD would remain responsible for their department as accounting officer. Wagner and the three other HoDs, in this case, have been relieved of their duties as HoDs.
"It is concerning," Engelbrecht said, "that we here have a very competent manager with a proven track record tasked with turning around the (health) department in a systematic way. Research has shown that stability in senior leadership in a department is a determining factor for success and for deepening leadership capacity."
She said there will be lots of uncertainties about initiatives already underway in the province's public health sector. Among these is 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, in summary there [may be] a lot of unintended consequences," she said.
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Mixed feelings
On Wagner's performance as head of health, some 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 a number of occasions to meet with 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.
Yawa said that it is confusing that people claim to be serving the people, but when structures representing the people reach out to them, they are nowhere to be found.
"We are aware of the intervention of Wagner in turning around the situation in the province with regard to reducing funds lost to medico-legal settlements. But we are not sure about other interventions of the HoD, which makes it difficult for us as TAC to say it was wrong or right for the Premier to remove her. We don't know what she was doing because if we go around in the Eastern Cape, the majority of the facilities have acting managers and CEOs," he said.
According to the secretary of DENOSA in the province, Veli Sinqana, the only communication the union received from the department concerning the HoD issue is that she is on leave. Sinqana said that the union hopes that the situation will not disrupt the department's ability to provide services.
"As stakeholders, we are aware of the challenges facing the department," he said. "Although we have been communicating with her (Wagner's) office, we understand that there are outstanding issues within the department. Among them are issues of filling vacancies, which we know are on the way."
NOTE: A member of the TAC is quoted in this article. Spotlight is published by SECTION27 and the TAC, but is editorially independent, independence that the editors guard jealously. Spotlight is a member of the South African Press Council.
