The country’s first post-apartheid director-general of the department of health, Olive Shisana, has never been afraid to speak her mind. She resigned in 1998 when then health minister Nkosazana Dlamini Zuma refused to accept accountability for the scandal related to the Sarafina 2 play about Aids she was in charge of. Shisana also confronted then president Thabo Mbeki over his Aids denialism.
It was no coincidence that President Cyril Ramaphosa’s announcement that GBV and femicide were a national crisis and needed to be treated as such came soon after Shisana was appointed his special adviser in 2018.
But Shisana concedes that eight years later — in spite of task teams, national strategic plans, summits, boards and ringing commitments — South Africa still has one of the worst rates of GBV, femicide, child rape and teenage pregnancies in the world.
She says this is because relevant government departments have failed to co-ordinate their efforts or support civil society organisations trying to fight the scourge.
The funding the departments receive is “not flowing through to civil society” or into rolling out co-ordinated prevention programmes across the country. “This is a whole-of-government crisis,” she says. “Isolated, small little projects are not going to stop GBV.”
The lack of urgency in addressing it is exemplified by the ongoing failure of the department of justice to publish a register of sex offenders, she says.
“Too many staff with such records are working at schools. The names of those who impregnate children should be publicised. That’s a prevention intervention that is not happening.”
Blaming the president for GBV is “problematic, when actually he set up an interministerial committee that is supposed to ensure that every department implements the measures it should take and sees that this information is published”, Shisana says.
Shouldn’t the presidency have exercised better oversight?
“Departments do not want to report. That is where the presidency has a problem, and it’s much more widespread than you can believe. We tried to encourage them to report how much they have budgeted for and what they have done with that money. Most of them did not.”
What does this say about the quality of ministers appointed by the president?
“I don’t think all of them are highly efficient. We need to see every minister saying at the end of every month what they’ve done with regard to GBV and what the effect of it has been. We don’t know what they’re doing; it’s a black box. It’s a priority for the country, but it’s a black box.”
Isn’t it the presidency that needs to hold them to account?
“Yes, you said it,” she says.
But, Shisana adds, “political sensitivities” make tackling GBV in South Africa “difficult”.
“There are sensitivities around who has perpetrated GBV. The issue of publishing the names of the perpetrators is sensitive.”
A major issue is the country’s “patriarchal culture”.
“It’s the men who are violating the women, and people do not want to publicise that information — to say so and so, a man they’re even married to, has impregnated a 15-year-old, a 10-year-old. That’s what we’re dealing with,” Shisana says. “We don’t know who those people are. If it were publicised and everybody knew, it would be very difficult for them to get away with it.”
The roots of the rot
Talking about South Africa’s collapse after the era of former president Nelson Mandela, Shisana, who retired last year and has just published her autobiography, says: “We need ministers who can lead with a sense of purpose.”
In the Mandela era, those who came into government as ministers or directors-general (DGs) had a clear purpose. “It was not money, it was not prestige, it was a calling. They were there for a particular purpose, and they had to execute that.”
After Mandela “every new minister came with their own plan. They disregarded what had been done. They hired DGs who were not so competent because they were malleable and would do whatever the minister said, instead of what the law or the programme required. Neither ministers nor DGs had the necessary qualifications for the job.”
Shisana is well placed to talk about the issue: after returning in 1991 from 16 years in exile with a DSc degree from Johns Hopkins School of Public Health in the US, she was assigned to the ANC’s civil service restructuring committee.
“We were very clear that appointments had to be based on merit,” she says.
So was cadre deployment a mistake?
“I don’t think so. It was the execution that was a mistake.”
People were hired without the right qualifications because they could be more easily removed if they didn’t obey instructions.
This was partly why the civil service became so dysfunctional and corrupt. But the corruption that engulfed the country started with the ANC’s introduction of the tender system, she says.
“The way the old administration ran before there were tender systems was better. Three people in a department would look for the best prices and then buy the most reasonably priced and effective. The introduction of the tender system by the new government created a problem.”
Though it wasn’t labelled as such, the new system contained “the element of BEE” nine years before the Broad-Based BEE Act was passed in 2003.
“Just setting up the tender system created entrepreneurs who had absolutely no experience or skill to come in and take state resources. This led directly to the Madlanga commission,” she says.
“If we had kept the system of buyers [procuring] what is the cheapest and most effective we would not be where we are today. Introducing middlemen led to us giving state money to people who had no clue about the sector.”
‘No culture of ministers resigning’
If accountability had been demanded after the first major corruption scandals, the arms deal and the R14.2m tender given to Mbongeni Ngema’s company for Sarafina 2, the country might also not be where it is today, says Shisana.
Should the minister have been held accountable for Sarafina 2?
“I don’t want to swim in the mud with Nkosazana [Dlamini] Zuma. I looked at it and said: ‘Why did this woman do this?’”
She won’t say if she thought the minister should have resigned. What she does say is that Dlamini Zuma blamed her for the scandal “and clearly, I had nothing to do with it. When I came in as DG [in 1995] she’d already met Ngema and they’d already agreed [to the project]”.
The findings of the public protector about the role of the minister, Shisana writes in her book, were “damning”.
As a result of the fallout between her and Dlamini Zuma, she left in 1998 and joined the World Health Organisation as an executive director.
“I resigned because we differed significantly in terms of how things should have been done. The culture is not that of ministers resigning.”
Is South Africa where it is because Mandela set a precedent of accommodating corrupt ministers rather than firing them, and this has been followed by Ramaphosa?
“Ramaphosa’s a consultative president,” she says.
Is this why, in spite of his promises of renewal, corruption under him got worse than it was under former president Jacob Zuma?
“If you listen to the Madlanga commission hearings then, yes, the corruption has become worse. People are not afraid of consequences.”
Should Mbeki have been held accountable for the 330,000 people who, according to Harvard University researchers, died because he denied them access to antiretrovirals?
“Yes, he should have been held accountable for that,” Shisana says.
By whom?
“The laws of the country. Lawyers should have filed a class action suit. A lot of people could have done that and they did not.”
Should the Human Sciences Research Council, where Shisana was then executive director for HIV/Aids, have held him accountable?
“Our job was to undertake research and provide the evidence to enable civil society to take action. They didn’t,” she says.
Shisana challenged Mbeki, and a prominent Aids denialist close to him said in a letter to the cabinet that she had “betrayed the country” by pushing a Western Aids treatment agenda.
Shisana became chair of the government’s National Health Insurance (NHI) advisory committee in 2009 and has championed it ever since.
She disagrees that looting of the estimated R400bn-plus NHI Fund will make it unworkable.
“A health system integrity architecture, which already exists, will protect it,” she says.
So why didn’t it protect Tembisa hospital?
“Because it cannot be implemented unless NHI is implemented.”
