Mireille Wenger was recently appointed to the Western Cape's top health job. Biénne Huisman chatted to Wenger about health policy, child health, and the challenge of providing quality public health services at a time of shrinking budgets.
Given the severe fiscal challenges facing South Africa's public health sector, it is perhaps unsurprising that on June 13 Western Cape Premier Alan Winde selected Mireille Wenger to take over in the province's health hot seat. The newly appointed MEC of health and wellness in the Western Cape, Wenger brings to the table two years' experience as MEC of finance and economic opportunities - a demonstrated flourish for pragmatism and a head for numbers.
Appointed DA chief whip of the legislature in 2019, Wenger is no newcomer to health. She has served on the provincial parliament's health standing committee, chaired its ad-hoc Covid-19 committee from 2020 to 2022, and spearheaded the parental leave policy for Western Cape parliamentarians.
Focus on policy development
Seated at a boardroom table on the 21st floor of the provincial legislature building in Cape Town's Wale Street, she tells Spotlight: "I joined politics because I'd like to bring change in the world. And I suppose if you ask any politician, they'll say: 'I want to make a change in the world'. But I've thought long and hard about how I can make that contribution real. And the best way I can do that, is policy development. And in the health space, I mean, that is the area that touches people's lives from birth to death, and everything along the way."
On her new beat and as a mum to a nursery school-going boy, Wenger says child health is near her heart.
"We have many children in South Africa that are malnourished and with other health implications. And what is the health department's response to that? How can we make a difference to make sure that children are nourished and can develop, and are able to reach their dreams and aspirations. How can I, through policy development, help children have a future?"
Asked what these child healthcare interventions look like going forward, she does not respond with specifics. On budget cuts at the Red Cross War Memorial Children's Hospital, she stresses "creating a sustainable budget for the health department; so that right across the board we can make sure we expand access to quality healthcare for all our residents, and in particular children".
Previously, Wenger served as chairperson for the Western Cape's standing committee on community safety. In 2011, she helped to develop the original pilot for the "walking bus" initiative in Delft - a collaboration that saw community members and volunteers walk children to school to ensure their safety. The project continued for around a decade, she says, with reasons for it ending being unclear. She recalls: "I think it ran for about a decade [under] the Western Cape government; eventually it was moved over to the City of Cape Town, a number of years ago; and I don't think it runs anymore."
Health and budget cuts
Wenger notes the challenge posed by the Western Cape's rapidly growing population.
"So one of the important challenges I'll be faced with is making sure that the health budget is sustainable. On the one hand, the Western Cape is the fastest growing province in terms of the population, as we saw in the census results. But unfortunately, the equitable share is not keeping pace with that population."
As with the country's other eight MECs for health, Wenger faces the tough challenge of maintaining and improving healthcare services in a context where provincial health budgets have been falling in real terms for several years.
Wenger points out that she inherited South Africa's only provincial health department to receive consistent unqualified or clean audits. Indeed, in the 2022/23 financial year, the Western Cape health department scored its fifth consecutive clean audit, in contrast to pictures of poor financial controls and corruption in most of the other provinces.
Last year, in her previous role as MEC for finance, Wenger was outspoken against national government's "unaffordable" public-sector wage deal - which culminated with a R1.1 billion shortfall across Western Cape education and health - and which the provincial government was "expected to magically fund". Along with Winde, she declared an intergovernmental dispute.
To Spotlight, she explains: "With the premier, I led the intergovernmental dispute against the public wage deal [against the country's Finance Minister Enoch Godongwana], which was a part of the source of the pressures on health - because there was that wage deal that was negotiated at national level, and then imposed on the Western Cape. And after the fight, we got 78% [of the R1.1 billion shortfall] of the funding, but we were still short for the rest, which is why there were those acute pressures last year in particular, in health and education..."
Each of South Africa's nine provinces gets a slice of the national budget which it then distributes between its provincial departments. How big a slice a province gets is determined by the equitable share formula, which takes into account several factors, including the size of a province's school-going population and usage of the public healthcare sector. While provincial health departments get some funds via other channels, the majority of their funding flows via the province and is thus impacted by how the equitable share is calculated.
Progress on parental leave
Wenger played a critical role in the development and adoption of the Western Cape Provincial Parliament's policy on parental leave for parliamentarians in late 2019.
"It was 2017, 2018; and I was the first in our legislature - that I could find - to be pregnant and to be confronted with just no maternity leave policy," she recalls.
"At the time, I was tasked to lead a sub-committee on developing a maternity leave policy - obviously a multiparty committee - and we did a lot of homework about, what is South Africa's legislation? How does it work elsewhere in the world? We did not want it to be narrowly, a maternity policy; so that all parents have the ability to bond with their child. So I was very pleased to be able to help develop this policy, to make it easier for other moms and dads to be parents."
The parental leave policy document states the Western Cape Provincial Parliament is taking a "bold step" to ensure rights for parliamentarian parents for maternity, paternity, adoption and surrogacy leave. "This policy is an active step to ensure public representatives are able to serve their province and look after their families. It should not be a zero-sum equation where parents, and in particular, women, are forced to choose between a career or family..."
Amongst its stipulations are that the primary care giver is granted four consecutive months parental leave after a child's birth, while the baby's non-primary care giver is given ten days leave. Then, following the adoption of a child under two years old, the primary care giver is granted ten weeks leave. In addition, a member of parliament who has a miscarriage during the third trimester of pregnancy, or bears a stillborn child, is entitled to maternity leave of six weeks.
Born in Johannesburg, Wenger holds an MA in international relations from the University of Stellenbosch and an MPhil in criminology, law and society from the University of Cape Town. She lives in Cape Town's southern suburbs with her husband, former executive director for corporate services at the City of Cape Town, Craig Kesson. In 2017, Kesson levelled allegations of misconduct against then-mayor Patricia de Lille. De Lille rejected the claims.
In the boardroom, by Wenger's side, interim spokesperson Georgina Maree is sitting in on our interview. Maree forwards background information as our meeting unfolds.
Building partnerships
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Wenger stresses the importance of building partnerships with academic institutions and the private sector, noting a project with Gift of the Givers. The humanitarian organisation donated a ten-bed overnight ward at the Eerste River Hospital which was opened last month. At the opening, Dr Naeem Kathrada, head of the Gift of the Givers' medical team in Cape Town, noted that the hospital's emergency room was flooded due to recent weather conditions. "Generally, patients must sit and wait for long hours in the waiting room with people walking past. We are very glad that we could partner with the Department of Health, and they were very grateful for the assistance," Kathrada was quoted as saying.
"So that's one example of the many partnerships I would like to increase during my term," says Wenger.
One such collaborative highlight between the government and an academic institution was the nearly-R300 million Observatory Forensic Pathology Institute officially opened by then health MEC Nomafrench Mbombo in April at Groote Schuur Hospital, adjacent to the University of Cape Town. Replacing the city's 1957 Salt River Mortuary - which was notoriously outdated and overfull, and described as a health hazard - the shiny new three-storey building integrates provincial health's Forensic Pathology Service and university training, with capacity for up to 20 autopsies a day.
We would have liked more time to probe the specifics of how the Western Cape plans to deal with a shrinking health budget, but wrapping up and rising from the table, Wenger says she is pressed for time.
A month into her tenure, she says she is still meeting health stakeholders across the province on her "listening and learning" tour - which she says includes "behind the scenes" infrastructure services. After our interview, Wenger says she is off to visit Tygerberg Hospital in Cape Town's northern suburbs, where she will inspect the academic institution's in-house laundry service. Called the Central Laundry, it employs over 90 people.
