6 May 2021
SAA was removed from business rescue this week after a receivership process which itself cost many millions more. Read more.
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6 May 2021
SAA was removed from business rescue this week after a receivership process which itself cost many millions more. Read more.
Civil society organisations have reacted with outrage to the draft budget of the embattled Makana municipality which proposes hefty salary increases for councillors and administration staff, funded in part by huge tariff increases for struggling ratepayers…
The Public Service Accountability Monitor (PSAM) conducted comprehensive analyses of the 2012/13 – 2015/16 budgets of the Chief Directorate: Environmental Affairs of the Eastern Cape Department of Economic Development, Environmental Affairs and Tourism (DEDEAT), and published brief reviews of the Chief Directorate’s respective budgets for the 2017/18 – 2020/21 financial years.
The complexion of the Chief Directorate’s budget remained essentially unchanged over these review periods, and for the 2021/22 financial year the situation is no different.
The 2021/22 budget of DEDEAT as a whole has increased by 21,2% relative to its 2020/21 adjusted appropriation, but whereas this increase incorporates the raising of the allocation to the Department’s Economic Development Programme by 28,8%, the raise for Environmental Affairs is just 7,3%.
In any event, the summary of PSAM’s key findings in relation to Environmental Affairs’ budgets for the 2012/13 – 2020/21 financial years, as captured in its 2020/21 budget review, is equally applicable to the Chief Directorate’s 2021/22 budget. This summary, together with recommendations which enduringly accompany them, is included below.
The quantum of the Chief Directorate’s budget has at no stage comprised more than between 0,40 and 0,49 % of the Province’s total fiscal envelope. Both the comprehensive analyses and the reviews can be accessed on PSAM’s website via http://psam.org.za/monitoring-advocacy/
Note: 2021/22 budget details are sourced from Eastern Cape Estimates of Provincial Revenue and Expenditure 2021/22, Eastern Cape Provincial Treasury.
By Andile Cele• 30 March 2021
On 21 March, South Africa commemorated Human Rights Day. In addition to remembering the horrors of the Sharpeville massacre of 1960, the intention on this day is to reinforce the commitments made in the Bill of Rights. This includes children’s rights as enshrined in Section 28 of the Constitution and Section 29 which guarantees everyone the right to basic education. While much has changed since the 1960s, painful inequalities in literacy and access to quality early education persist in South Africa.
Globally, over 43% of children under the age of five are at risk of not fulfilling their full developmental potential due to risks of poverty, poor nutrition and a lack of access to basic services and early enriching opportunities. In sub-Saharan Africa, 36% of adolescent girls are excluded from school. In Malawi, 95% of Grade 2 students are unable to read a single word, while in South Africa, 16% of Grade 3 pupils are unable to meet the lowest level of literacy, showing that harmful, lifelong literacy gaps begin at an early age.
Early Childhood Development (ECD) is therefore an integral part of development that requires dedicated resourcing, a progressive policy environment and robust governance. The Children’s Act (2005) defines ECD as “the process of children developing their emotional, cognitive, sensory, spiritual, moral, physical, social and communication capabilities from birth to school-going age”, making this sector critical for the early introduction and development of learning and social skills.
The National Development Plan (NDP) “recognises quality early childhood development… as a sustainable and cost-effective way of ensuring the optimal development of children [and]… as a key lever to overcoming the apartheid legacy of poverty and inequality”. The South African government has taken steps to prioritise the sector by introducing the ECD conditional grant in 2017, which is managed by the Department of Social Development (DSD). The primary objective was to address inequality while increasing the number of children accessing ECD services and subsidising centres that offer ECD services to children from low-income households.
The importance of a strong ECD sector has been widely reported, acknowledging the lifelong impacts good foundational education has on long-term education outcomes and earning potential in adulthood. The converse can be said as well — a lack of a good early childhood education can trap families in generational poverty cycles that may take longer to break out from. This sector has the potential (if fully and deliberately developed) to help bridge the widening inequality gap in South Africa in the long term.
The services ECD centres offer to go beyond a place to leave a child for the day — they provide meals that some families may not have access to; provide mental stimulation that some parents or guardians are not equipped to deliver; and place children in an important environment where they interact with contemporaries as well as adults, which fosters faster language and reasoning abilities and skills.
The system, therefore, cultivates a holistic approach to learning, not just cognitive stimulus, but social development. The Lancet series defines this as nurturing care — an environment that brings together health, nutrition, security, safety, responsive caregiving, and early learning. This must be provided in symbiosis by parents and family interactions as well as the ECD environment that enables these interactions.
There is now a proposed migration of ECD services to the Department of Basic Education (DBE) from the Department of Social Development but, as South Africans, we know that the public basic education sector has failed to fulfil its current mandate. Therefore, requiring it to take over this critical sector would not only further cripple the DBE but negatively impact the lives of millions of children. The DBE’s history with poor education and general programme outputs should be a major concern. Triple legal challenges have been levelled against the DBE by civil society groups for its inability to ensure equal access to basic education and inability to provide safe basic services, resulting in the deaths of learners. This does not sound like a sector equipped to handle smaller children.
Basic education and service delivery
South Africa’s basic education sector is marred by inadequate delivery on infrastructure, water and sanitation, which has grave consequences on the learner experience, as highlighted by the Public Service Accountability Monitor (PSAM). With over 3,000 schools across the country still using pit latrines and well over 7,000 relying on rainwater harvesting, this is not a sector equipped to take on early childhood development in the immediate to medium term.
Water, sanitation and hygiene (WASH) are so important in ECD that the sector being taken over by an already struggling department could be detrimental to children’s health, development and safety.
The DBE has failed to fully implement the Norms and Standards for school infrastructure, failing to meet both the 2016 and 2020 norms deadlines. Not only that but in the Eastern Cape 147 schools’ water has been cut off due to non-payment, indicating a department already overburdened.
The funding for infrastructure in the department is set to be reduced by R413.3-million over the medium term. The Budget Review (page 59) shamelessly states that “low compensation growth of 0.8 per cent over the MTEF period, combined with early retirements, will reduce the number of available teachers. This, coupled with a rising number of learners, implies larger class sizes, especially in no-fee schools, which is expected to negatively affect learning outcomes”.
This is a blatant admission that the sector cannot provide equitable education to the poorest learners in this country.
Learning outcomes in the basic education sector
Learning outcomes within the sector have not reciprocated the financial investment in basic education, which on average is above the Organisation for Economic Co-operation and Development (OECD) average of 3.1% of GDP. In 2016, South African learners ranked last in reading scores in a sample of Grade 4 learners from 50 countries participating in the Progress in International Reading Literacy Study (PIRLS). South African learners, therefore, exhibit substantial deficits in critical learning skills at early levels of education. These deficits in critical literacy skills not only persist throughout higher levels of education but ultimately spill over to all other subjects.
The ability to read and learn in an enabling and safe environment is critical for early cognitive development, therefore serious consideration needs to be made before the official merging of the ECD programme to the DBE, a government department that has failed to meet its own annual targets in service delivery and learner outcomes. The ECD programme needs practitioners and academics to help create a department that will not only protect learners and their education but strive to produce life-long outcomes that can compete at international levels.
Over several years, the department has failed to meet annual targets on infrastructure development and the provision of water, sanitation and electricity. These services are critical to the development of a thriving ECD sector with the required resources to create a conducive learning environment. Chronic underspending, fruitless and wasteful expenditure and maladministration have characterised governance of the basic education sector.
Therefore adding ECD to the DBE’s portfolio must be accompanied not only by adequate human and financial resources but clear monitoring and implementation plans. This is especially true within any inter-departmental programmes that have associated governance structures — clear systems of transparency and accountability are pivotal. Failing to meet the learning needs of South Africa’s children will continue to mete out the highest cost imaginable to the country’s development agenda. DM
Andile Cele is a research and advocacy consultant at the Public Service Accountability Monitor as well as coordinator of the Budget Justice Coalition, a network of South African civil society organisations working collaboratively to build people’s participation in and understanding of South Africa’s budget and planning processes.
By Tlamelo M Mothudi • 17 March 2021
Nomakhosazana Meth takes charge of the Eastern Cape health department at a time when the provincial economy is estimated to grow by only 2%-3% in 2021. In addition, the province has an unemployment rate bordering 50%.
With so many people out of work in the Eastern Cape, there will be a high reliance on government services and a pressing need for the economy to recover as quickly as possible.
The health department faces a R7.2-billion reduction in budget in 2021, and a further R28.2-billion over the next three years covered by the Medium-Term Expenditure Framework (MTEF).
As of 17 March, 2021, only the Budget Speech had been published online. Without specific details of the budget allocations, as would be tabled in the estimates of provincial revenue and expenditure (EPRE) and the Appropriations Bill, efforts to accurately determine the socioeconomic effects of budgetary changes are hampered.
The Public Service Accountability Monitor (Psam) has requested these documents from the provincial legislature, but they have still not been provided.
On the Eastern Cape treasury’s website, the most recent EPRE dates back to 2015. Yet the details of programmes in sectoral budgets such as health and education, as well as on specific programmes and conditional grants, are important for assessing and refining policies for better results.
Following the tabling of the 2021 national Budget, various civil society organisations, social movements and trade unions endorsed a letter written to the standing and select committee on finance, calling on Parliament to reject the 2021 national Budget as it fails to protect human rights.
Nationally, public expenditure will be cut by R265-billion over the next three years. These cuts will be felt most at provincial and local government levels.
Improving services on a shrinking budget
While in office, it is MEC Meth’s responsibility to address the ailing healthcare system and build more equitable healthcare for all. It is hard to see how this can be done.
In the 2021/22 financial year, provincial equitable share for the Eastern Cape amounts to R68-billion. R13.2-billion is for conditional grants and R1.5-billion is “provincial own revenue”.
In 2020, the province recorded reductions of R4.5-billion from the equitable share and conditional grants over the MTEF. In 2021, the province faces cuts of R28-billion over the MTEF – R23.5-billion more than was cut in 2020.
Cuts to the provincial budget come at a time when the contracts of 5,000 community health workers (CHWs) are scheduled to be terminated by the end of March 2021. This is happening due to a lack of resources and spikes in medico-legal claims.
With R22.8-billion of the R28.2-billion in cuts to the province coming from the compensation of employees budget, service delivery is bound to be impacted by the reduction in staff numbers.
Furthermore, with Covid-19 having already wrought havoc on the health system in the province, cuts to compensation of employees will result in clinics and hospitals suffering shortages of personnel and an increase in overworked staff.
This, while departments are encouraged to “prioritise the review process of their organograms to ensure that core service delivery posts are protected and non-core posts minimised so as to improve the capacity of the state to deliver”.
Even before the pandemic, healthcare in the province was in crisis. Among the key concerns listed by the Treatment Action Campaign in its 2018 state of the province healthcare report were “a critical staff shortage, poor facility infrastructure and equipment” and the “dire state of emergency medical services and planned patient transport”.
The country’s recently adopted 2030 Human Resource for Health strategy projects that in the Eastern Cape, 97,000 healthcare workers – a third being CHWs – would be needed to bring staffing up to equitable levels by 2025. This would mean an additional 88,000 workers for the primary healthcare system alone.
According to the strategy, 16,000 nurses are required across the province by 2025. As at 31 December 2020, the South African Nursing Council recorded 28,745 nurses per population of 6.7 million in the Eastern Cape. The population per qualified nurse in the Eastern Cape is 234:1.
The province’s allocation towards health infrastructure over the MTEF amounts to R5.8-billion.
In its 2020 budget analysis, Psam found that “between 2019 and 2020, the health facilities infrastructure management sub-programme increased by a mere 1% in real terms”.
This 1% increase, in a province with some of the worst infrastructure historically, will not go far in addressing infrastructure challenges. The sub-programme underspent by 6.7% (R142,000) while the programme was unable to meet its service delivery objectives. This indicates an urgent need for sound financial control mechanisms to ensure that allocated funds are spent better.
According to the Constitution, a budget must address socioeconomic rights and the needs of those it seeks to serve. But, as it stands, the health budget will continue to underdeliver on its mandate instead of progressively realise or protect rights.
The new MEC has a lot of work ahead of her and the eyes of everyone in the Eastern Cape will be on her while she does it. DM/MC
Tlamelo M Mothudi is the Health Researcher for the Public Service Accountability Monitor, a 2021 Master’s candidate and a 2021 Tekano Atlantic Fellow.
Long before Covid-19 hit, the Eastern Cape health system was already in crisis. Years of neglect are evident at the flagship Livingstone Hospital in Gqeberha, designated as one of the province’s main Covid-19 hospitals. The peeling paintwork, grimy entrances and occasional broken window seen from the outside reflect the state of affairs on the inside.
In November, about the time that Médecins Sans Frontières pleaded with doctors in its network to volunteer at the hospital, GroundUp visited the hospital covertly with a staff member. The staffer revealed that a 50-bed Covid-19 emergency ward, set up in what was formerly a parking basement, had never been used as the hospital was apparently too short-staffed to man it. The beds still had the protective plastic covering they were delivered in.
Half of another 32-bed Covid ward on the first floor, donated by Investec, had been given over to psychiatric patients. When the power failed about a month after the ward opened, it was discovered no backup power had been secured, nor any warning systems put in place.
Staff shortages meant the 16-bed intensive care unit (ICU) ward was often reduced to 12 beds at night because, as each patient in ICU required a nurse, there simply weren’t enough nurses.
The number of beds available in wards was also often reduced because equipment at the workshop, needed for repairs, was broken. Even plugs – essential at each bed for the operation of equipment, some of it life-saving – were not always fixed. A look-in at the repair workshop revealed one technician surrounded by broken and faulty equipment covering every surface and overflowing onto the floor space.
Basic things such as broken windows and door handles were not fixed. In the public areas, such as the toilets, metal fixtures such as door handles and the metal coverings of urinal flush levers in the toilets were missing, probably stolen for scrap.
Another senior staff member said that, due to a shortage of porters, laundry was not being done.
The South Africa Medical Research Council’s weekly mortality reports confirm that, of all the nine provinces, the Eastern Cape has recorded the most excess deaths since May 2020, just under 33,000. At nearly 500 excess deaths per 100,000 people, the province has been hit far worse by Covid than any other province (KwaZulu-Natal is next at 310 per 100,000).
But the problem is much older.
As far back as 2004, the Public Service Accountability Monitor (PSAM) warned in a report that public health care in the province was in crisis, citing overcrowded hospital wards, dilapidated infrastructure, food shortages, broken-down ambulances and neglected state mortuaries. The report questioned the provincial government’s commitment to “deliver efficient and effective public health services to meet the province’s needs”.
The Treatment Action Campaign’s State of Provincial Health Care Report in 2018, based on information from its network of 26 branches, found that little had changed. It cited “a litany of critical concerns with regard to the service delivery at clinics and community healthcare centres across the province”. Among the key concerns listed were a critical staff shortage; poor facility infrastructure and equipment; and the “dire state” of emergency medical services and planned patient transport.
That same year, a Health Ombudsman report into allegations of malpractice and human rights abuses at the Tower Psychiatric Hospital in Fort Beaufort found that the provincial health department’s leadership and governance was in “disarray”, that the work ethic within the department had “severely deteriorated” and that the department “failed to instill consequence management to hold senior staff accountable”.
Poor controls in supply chain management have allowed corruption to flourish, says Zukiswa Kota, PSAM’s head of Monitoring and Advocacy.
But, she adds, budgeting and contracting in the province is so opaque that catching corrupt activities in real time is virtually impossible. Even members of the provincial legislature — tasked with exercising oversight over the executive arms of government in the province — are often dependent on “after the fact” audit findings to identify spending irregularities, she says.
A rare exception to this opacity came in the early 2010s when the department’s incoming director-general Siva Pillay set out to identify trends in the graft, recoup lost funds and purge corrupt officials from the department.
Pillay shared some findings with us from a departmental Risk Management Project presentation from 2010, describing the types of corruption uncovered within the department: nepotism in hiring and the selling of jobs, “widespread” theft of medicines and supplies, the falsification of quotations and other documents, false overtime claims by staff, duplicate payments made to suppliers, department employees or their families doing business with the department and an array of other anomalies in the department’s supplier database.
Speaking from his private practice in Kariega (Uitenhage), Pillay said the corruption was enabled by a general lack of spending controls and a system of patronage that was upheld by some of the department’s most senior officials.
He said there was a pattern of department officials incurring expenses and making unapproved payments to companies – often companies in which they themselves had a stake or interest – and then making up excuses to justify the expenses after the fact. The money was almost never recouped and officials rarely faced consequences.
“Everybody was in on it… even an ordinary sister at the clinic, if she’s procuring something she has to get three quotes. She didn’t even bother, because she just went to her three friends to obtain quotes,” he said.
Against the backdrop of state capture, the corruption which flourished during the first phase of government’s emergency Covid-19 procurement was to be expected.
“If you trace things back far enough you will find that at some point there was … politicisation of the procurement function, whereby politicians used powers of appointment, promotion and dismissal and so on to position people open to manipulate the system at the right points and to cross-cut checks and balances and manipulate processes,” says Ryan Brunette, a researcher at the Public Affairs Research Institute.
“You can have your way with procurement at that point. This is what we would call state capture. And that happens fairly pervasively across the South African system.”
Though it is impossible to thoroughly reform the system in the short-term, Brunette says some short-term solutions are possible.
One may be the creation of financial incentives for whistleblowers who can provide evidence of corruption and help the state recoup losses. Payouts to whistleblowers who defect would make it more difficult for corrupt networks within the state to function, as they could no longer trust those within their ranks for fear of defection. Good public servants would be emboldened to speak out. It would also lighten the burden on South Africa’s already oversubscribed law enforcement agencies, such as the SIU, who have been on a massive and resource-intensive fact finding mission since President Cyril Ramaphosa ordered that most Covid-19 procurement contracts be investigated for fraud.
There is ample historical precedent for such a system during times of crisis — the United States False Claims Act, also known as Lincoln’s law, incentivised whistleblowers to curb conmen from selling fake military supplies to the Union Army during the American Civil War.
Such measures are unlikely to take root in South Africa in time for the vaccine roll out, mainly for political reasons. Powerful people would see such a mechanism as a threat and, in any case, the country’s policy-making processes are generally too slow and conservative, says Brunette.
Something more politically feasible and in keeping with the South African tradition may be the empowerment of civil society monitors to observe and investigate the roll out of vaccines and procurement contracts.
Meanwhile, the province’s health workers are managing as best they can. Asked how she, and other staff members maintained morale and managed to continue treating the patients even as Gqeberha was beginning to experience a second wave of coronavirus infections, the staff member at Livingstone Hospital said that every Thursday morning, an increasing number of staff had gathered together before starting their shift.
“We pray,” she said – a prayer for the strength to continue healing the sick and the injured.
Part two will be published on Thursday. Produced for GroundUp by Viewfinder and West Cape News.
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