The reappointment of Dr Aaron Motsoaledi as the Minister of Health has been met with divisive views. Motsoaledi was the Minister of Health from 2009 to 2019. Before his reappointment to health on Sunday, Motsoaledi served as the Minister of Home Affairs. 

Director for HIV and TB delivery at the Bill & Melinda Gates Foundation and extraordinary professor in the Department of Global Health at Stellenbosch University, Dr Yogan Pillay, fully supports Motsoaledi’s appointment.    

Pillay, who served as the deputy director general in the national health department during Motsoaledi’s tenure, says he will support the minister “in any way I can”.

But veteran HIV clinician and health researcher at the University of Witwatersrand, Professor Francois Venter, disagrees. 

“Motsoeledi came into power in 2009, with lots of promises and a 10-point plan. However, none of the 10 points were implemented. He instead blamed foreigners and NGOs for the multiple management failures under his administration,” he tells Health-e News. 

Venter says Motsoaledi left the health ministry significantly weaker than when he found it.

“Now he returns from Home Affairs after a similar failed 10-point plan and multiple embarrassing events,” he says. 

The South African Medical Association (SAMA) says it is not concerned about the personalities of those appointed to the health portfolio. Rather, the organisation is worried about the addition of portfolios to an already bloated administration.  

SAMA chairperson Dr Mvuyisi Mzukwa says adding more members to the cabinet contradicts the urgent need to streamline government for the sake of efficiency and better allocation of resources. 

“We are disheartened by the expansion of the cabinet, which we see as a missed opportunity to reallocate crucial funds to our struggling healthcare system. Our nation faces important health challenges that require immediate and substantial investment. This expanded cabinet diverts essential resources away from where they are needed most.” 

Regardless, the association is committed to working with whoever is appointed in the health ministry.

“Our primary concern remains the health and well-being of all South Africans. We will continue to advocate for measures that improve service delivery and health outcomes,” Mzukwa says. 

Track record

While Motsoaledi is not new to health, Pillay believes he will come back with new and fresh ideas.  

“But he also doesn’t have all the answers, and he knows that. From my years working with him he’s always been open to new ideas,” says Pillay. 

The minister’s record, he says, speaks volumes. From 2008 South Africa saw an increase in life expectancy. There were reductions in the newborn, infant and child deaths. At the same time, the country expanded access to HIV treatment. Today South Africa has the largest antiretroviral therapy programme in the world. 

The South African Medical Association Trade Union (SAMATU) says it is confident that Motsoaledi’s deep understanding of the South African healthcare landscape will prove invaluable as he has a commendable track record in addressing critical health challenges. 

“His proven dedication and extensive experience in the healthcare sector make him the ideal leader to steer our nation towards a more equitable healthcare system. He has made significant reforms to improve the health of all South Africans,” says SAMATU general secretary Dr Cedric Sihlangu.

He says the trade union believes that Motsoaledi possesses the vision, commitment and expertise necessary to successfully implement the National Health Insurance (NHI). 

“His reappointment comes at a crucial time when the NHI’s foundational structures are being established. His leadership will be instrumental in ascertaining that this transformative healthcare reform is realised seamlessly and effectively.” 

Residual issues

The Democratic Nursing Organisation of South Africa (Denosa) says it hopes that Motsoaledi will do things progressively and differently this time. 

“There were issues previously that we were not happy about. However, we hope that his reappointment will present an opportunity where we get along very well in terms of how nursing should be in the country,” says Denosa spokesperson Sibiongiseni Delihlazo.

There are major issues when it comes to nursing education, which he says was Motsoaledi’s idea. 

“The process of nursing curriculum change has brought about serious challenges. As a result a nurse who studied for three years struggles to take care of a pregnant woman if they work alone as they are not well equipped. We hope to engage with the minister to see how we can move forward with this,” he says. 

Way ahead 

Whether he’s new to the job or an old hand the Minister of Health has his work cut out for him. The inequalities in South Africa’s society such as the social issues exacerbated by the COVID pandemic, increasing unemployment as well as heightened food insecurity all have a devastating impact on public health.  

“It’s not an easy time for him to come back, but I don’t think there ever will,” says Pillay. 

“The NHI is law now and must be implemented. This will be an obvious priority, but it remains to be seen what he will prioritise for implementation.”  

Funding has been central to health challenges of late with unemployed health professionals taking to the streets and some sleeping in front of provincial headquarters demanding placement. 

The Health Funders Association (HFA) proposes a “to do list” for the minister. 

• Build opportunities for collaboration: “The HFA would welcome mechanisms for more engagement and collaboration to build capacity and develop wider access to quality healthcare,” says the organisation’s chairperson, Craig Comrie.
• Improve public health facilities in preparation for NHI: “As the NHI Act has now been signed, public health facilities will need a significant overhaul, effective management and collaboration with all health stakeholders to become fit for purpose before the NHI can begin to function,” he says. 
• Address overdue regulatory reforms: “Finalising the Low Cost Benefit Options framework and committing to regular reviews of the Prescribed Minimum Benefits to ensure sustainability and relevance to medical scheme members’ needs would reduce the costs of medical scheme membership. This, in turn, could expand access to private healthcare for millions of South Africans while alleviating some pressure on the overburdened public healthcare system.” 

Healthcare service delivery in the public sector, supported by private healthcare collaboration, will be the greatest litmus test of the new Government of National Unity,  Comrie says.  – Health-e News