The deployment of the relatively unknown Dieketseng Mashego as Limpopo's new MEC for health has raised eyebrows. Ufrieda Ho rounds up some responses to her appointment.
Limpopo's health MEC Dieketseng Mashego has clocked up her first 30 days in office. Some of those who will engage with her in the coming years are taking a wait and see approach to the little-known politician. But they caution that the job of fixing health service delivery in the country's second poorest province is urgent.
Mashego comes to the key position in Premier Dr Phophi Ramathuba's executive council with no previous experience in the provincial legislature and no health sector background. The 38-year-old is Ramathuba's successor as MEC for health with Ramathuba having been promoted to the province's top political spot. Mashego was part of the Sekhukhune regional executive council for the ANC and was speaker for the Elias Motsoaledi local municipality.
Despite several efforts to get comment from Mashego over the last week and initial indications from her office that she would respond, questions Spotlight sent her have gone unanswered (see more details at the end of the article).
Mashego's Facebook page includes posts and photos about her political engagements since taking office on 13 June as MEC as well as her ANC campaigning ahead of the May 2024 elections. She lists her work experience as time spent at the National Rural Youth Service Corps within the Department of Agriculture, Land Reform and Rural Development - no position is given. Before that she was an admin assistant in the Department of Education and she lists that she studied at Unisa and Sekhukhune FET College.
Six active directorships
Mashego has six active directorships according to Companies and Intellectual Property Commission records. Her name is listed as first director for Abenzi Business Enterprise, based in Dennilton, the area where she is from. The nature of the business is unclear. The other five companies are construction-related entities.
The EFF is the official opposition in the province. Provincial leader Lawrence Mapoulo says Mashego must declare her directorships and any other potential conflicts of interest. He adds: "The policies are very clear about how you must conduct yourself; she is a citizen of South Africa and she must observe the laws of the country."
Reserving judgement
Mapoulo says that the EFF welcomes a younger cohort of leaders in the provincial legislature and that they will not judge Mashego's performance as health MEC prematurely.
"We need the energy of young people and the EFF will give her 100 days in office. We will observe how she works, how she interacts with the opposition parties - even the smallanyana parties - and to see if she will be guided by the voice of reason," he says.
Mapoulo identifies three key health-related priorities for the EFF. He says: "We need to insource security in clinics and hospitals. Second is to ensure that doctors that are lingering must be absorbed to all our clinics and hospitals so they can serve the nation and lastly, we must do away with the tendering system and focus on absorbing the majority of people so they can be employed."
According to the Quarterly Labour Force Survey, unemployment in the province stood at 47.8% in the first quarter of 2024.
Mashego takes over a portfolio that for the 2024/2025 period has a budget that increased by just over 3% from the previous year (a below inflation increase). It stands at R24.6 billion, which is made up of R20.3 billion from the province's equitable share, R4.1 billion conditional grants and R220.6 million from the department's own revenues.
Every cent will be needed. The province is battling with a high number of unfilled posts, crumbling infrastructure, and the challenge of delivering services to rural communities.
Another mounting concern for the Limpopo government is food insecurity. In a July 2023 paper, researchers estimated that 52% of Limpopo households do not know where their next meal will come from. Persistent malnutrition exposes children to health risks including stunting, wasting and immune weakness, according to the World Health Organization.
Health system challenges
At a clinic-level, there are challenges too. Ritshidze is a multi-partner project focused on community-led data collection and analyses of healthcare services at clinics across the country. They surveyed 303 users of Limpopo clinics in the first quarter of 2023 - 78% of clinic users said waiting times at clinics were too long. Based on their data Ritshidze estimates the average clinic waiting time is 2.38 hours per visit.
They also found that the province lags in giving stable HIV positive patient multi-month scripts. Multi-month scripts save patients time in queues and transport money. It also eases congestion in facilities. Ritshidze found that only 12% of patients are on the preferred three-month script refill. It also found that only 56% (compared to the national average of 94%) of people living with HIV were in the past year given a viral load test (an important monitoring test that measures the amount of HIV in a person's blood).
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The Treatment Action Campaign (TAC) is one of the partners of the Ritshidze project. Daniel Mathebula is TAC Limpopo provincial manager. He says that TAC would have preferred to have an MEC who has a healthcare background. He says: "Since 1994, we have had a bad history of MECs who are not doctors in the province. With Ramathuba, she had professional experience being a doctor so she did understand the challenges better.
"We are not sure whether the new MEC will deliver. We at TAC had never heard of her before her appointment. But we'll give it time, try to meet with her and see what happens going forward."
Mathebula says the priorities for Mashego should be to address staff shortages and to fix infrastructure at clinics and hospitals. Added to this, he says, the MEC should be sorting out glitches that have seen lab services through the National Health Laboratory Services result in patients not getting their test results timeously or at all, in some instances.
He also says TAC is receiving complaints about mobile clinics that exist but are seemingly not offering a proper service. He says: "We are hearing from rural communities that the mobile clinics stay for only a few hours each visit but we see many mobile clinics parked in town when they should be delivering services."
Mathebula adds: "We need an MEC who is committed and transparent. She must be able to work with all stakeholders and civil society because we are the people who know what's happening on the ground."
'Too many vacancies'
The Democratic Nursing Organisation of South Africa in the province says a priority for Mashego should be to make acting positions permanent, including that of chief nursing officer in the province.
Jacob Molepo, the union's provincial secretary, says: "The issue of staff vacancies must be resolved. We have high staff turnover in the province; some of this is due to natural attrition but we also see people leaving for greener pastures in other provinces or the private sector.
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"Each month we are seeing around ten staff go on retirement, so we also need to prioritise nurses training."
Molepo says there must be a strategy to support nurses working in rural communities. He says as the province has pushed to have more 24-hour clinics it has not matched this with adequate staff employed. He says: "Sometimes you'll find there are only two nurses attending to 100 patients a day and the working conditions in a rural area has challenges; so nurses are exhausted and that's why they leave."
"We are prepared to work with the new MEC and we will not prejudge her. We will meet and put our expectations on the table," he says.
The MEC's office was contacted for an interview, but director of communications Neil Shikwmabana asked for written questions. Mashego's spokesperson Samuel Modipane also received the questions. He said he would try to get Mashego's responses then redirected questions to Shikwmabana. After several prompts and an extended deadline, there has been no response.
Questions put to Mashego included for her to outline her priorities for the health department; what she felt she would be bringing to the role; outlines of her background and personal management and leadership style; how she intends acting on corruption; staff shortages and optimising a shrinking budget. Mashego was also asked about her directorships, conflicts of interest and what bearing these have on her as a public official.
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