Controversy and cautious hope collide as Masechaba Sesing heads up Free State health department

30 Apr 2025

With a new head, there is quiet optimism in some circles that a turnaround in the Free State Department of Health’s fortunes could be on the cards. Masechaba Sesing talked to Spotlight about her plans for the department.

Interest in the appointment of the new head of department (HOD) at Free State health has churned with equal parts controversy, confusion, and cautious hope that the beleaguered department — in a beleaguered province — can steady itself.

Masechaba Sesing has been in the role for about five months, having been moved into the position last November after serving seven years at the provincial treasury, leaving that department as HOD.

The chartered accountant previously worked at the Auditor General of South Africa. Prior to that, she had stints on international audits for the United Nations and the African Union.

Her transfer from treasury to health was surprising for some watchers of provincial politics. It came after the treasury had achieved three successive clean audits under her leadership. A shift to the health department could arguably have been seen as a demotion.

Sesing did run into some headwinds at the treasury though. Noticeable were allegations of inappropriately interfering in the appointment of senior staffers. It led to her being investigated by the Public Service Commission in two separate cases. She allegedly favoured candidates she was alleged to have personal connections with. One case has been found to be unsubstantiated; the second case is ongoing and Sesing has denied acting improperly.

It was against this background that Sesing took up her role as health HOD, which is considered to be among the most complex in provincial government, overseeing what is usually one of the two largest budget allocations in the province.

Optimism in the face of challenges

There has been cautious optimism from some for what they see as her willingness to act on fraud and poor management. Her background in finance is regarded as an advantage to right a department crippled by long years of alleged corruption and maladministration. Challenges include the payment of ghost workers, long unfinished infrastructure builds, alleged overpayment for inferior equipment, high debt to suppliers, and an absent budget to prioritise the filling of about 5,000 vacancies.

Like other senior officials in the province, she also has to navigate the province’s thorny and unstable politics.

The Free State is led by Premier MaQueen Letsoha-Mathae who came into the role in June 2024. By August that year, she faced court action over a planned reshuffle of HODs. Mosa Masitha, who was HOD of the Human Settlements Department, challenged her transfer to the Social Development Department. She argued in court papers that her contract was set to run till September 2027 and that she had not been properly consulted about the move.

The premier and Tumelo Phahlo, who at the time was appointed in Masitha’s place at human settlements, were found in contempt of court when they failed to arrive for proceedings. They were ordered to jointly pay costs and Letsoha-Mathae was ordered to reinstate Masitha. This did not happen. Masita is now HOD of Public Works and Phahlo is HOD of social development.

Letsoha-Mathae’s critics have slammed her leadership style as dictatorial and claimed that some of her decision-making disrupted efforts to improve the running of the province.

By October, there was more to come as the premier and her husband Lawrence Mathae, who is the Speaker of Mangaung Metro, came under investigation. The Directorate for Priority Crime Investigation (the Hawks) is investigating allegations of corruption and money laundering to the tune of R4.5-million that relate to a road construction contract during the time that the premier was the MEC for Community Safety, Roads and Transport.

The couple has denied the allegations, according to the SABC.

‘Health was keeping her awake at night’

It is amid this volatile political climate that Sesing sat down for an online interview with Spotlight at the end of February. Publication of the interview was delayed due to speculation that Sesing was to be moved out of the department. The spokesperson for the health department, Mondli Mvambi, told Spotlight the rumblings in mid-March of another reshuffle were “speculative” and “only rumour”. The premier’s office did not respond to Spotlight’s questions.

One of the first questions put to Sesing was about politics and precarity and how she intends navigating these in a department she has landed in as an outsider.

“It would have been nice to continue at the treasury because I had already done a lot over the past seven years. But I don’t blame our political principals for moving us around because they want to see changes, impact and service delivery,” she said.

Her relationship with the premier was a good one, said Sesing, adding that she didn’t feel slighted when moved to the health department.

“I know that the premier has good intentions, and she’s got my best interests at heart. (The move]) was something she personally spoke to me about. I knew that among other departments, health was one that was keeping her awake at night,” Sesing said.

We need to be productive

She said that people working in the government often became complacent.

“In the private sector, you won’t sit for long without performing. So, it’s high time we government officials wake up to the reality that we need to be productive,” she said.

Since taking up the role, Sesing said she had been making unannounced weekend visits to clinics and hospitals. The aim, she said, was to go beyond reports and spreadsheet data to truly understand the realities at facilities in the province.

“I don’t arrive in a place believing that I am working with crooks, so we begin with understanding what is happening — could it be a case of needing training or better tools?”

For Sesing, being on the ground was a way to build a foundation for consequence management. This style of management was needed to change organisational culture and build efficiencies in the department, she said.

“Consequence management is not punitive and the employee should know what is coming because they should understand at every point what is expected of them. And we need to build efficiencies, otherwise whatever money we have in a budget will never be enough,” said Sesing.

Need for better financial discipline

The current Free State Health budget stands at R13.71-billion, a 4.8% increase from the previous year. Sesing stressed the importance of financial discipline to make this money go further.

She outlined a few priority targets toward this objective of improved financial discipline.

“The department must be paying the South African Revenue Service and other third parties in the last month of the financial year, but that’s not what’s been happening. Everyone, from hospitals to the different departments and municipalities, must be submitting their financials, but that has also not been happening,” she said.

Currently, the health department has only achieved one part of a three-part checklist to qualify for a clean audit.

“I want to work on bringing down irregular expenditure and to get to the bottom of why there are procurements happening outside of government’s prescripts,” she said.

Sesing said the deterioration of healthcare services had been dire. She wanted to understand nurses’ workplace challenges, but at the same time to address why productivity and professionalism continue to be flagged as problems by patients.

‘Professional and kind’

The mother of two, who grew up in Driehoek, said she was raised by her grandparents in her early years as her single mom looked for work in Bloemfontein.

Sesing said she remembered going to Pelonomi Hospital in Bloemfontein as a child in the late 1980s, where her mother had regular check-ups for her back.

“I remember that the floors at Pelonomi were the shiniest I ever saw. The nurses were all in white and they were so professional and kind. I found myself dreaming that I wanted to be part of them. I remember they also gave me lunch, which was mashed potatoes and peas and chicken and pumpkin. And when they saw I was finished, they would give me malva pudding and custard. I wished that my mother could have check-ups every day. But if you go there now, it’s the flipside of this,” she said.

Pelonomi has in recent years suffered from surgical backlogs. There are ongoing reports of shortages of basic medical supplies and equipment. On an official government visit to the hospital in July last year, the premier criticised the hospital for its long waiting times. Patients who arrived at 7am to join the queue were still waiting at 1pm.

When asked, Sesing admitted that the only public health facility she would be comfortable using in the province was the Universitas Academic Hospital.

She also acknowledged that the province was lagging in being ready for any implementation of National Health Insurance. Only four facilities at a district level met the “100% criteria for the ideal hospital or the ideal clinic” to fulfil the aspirations towards universal health coverage. Sesing said the key block was around infrastructure builds that had not been completed. She committed to a three-year timeframe to bring infrastructure to an acceptable state.

‘I don’t take a lunch break’

She honed in again on work ethic and leadership, adding: “Nurses have every right to take their breaks and their lunchtime but we need to understand that doing the bare minimum is not going to save our health system or patients if we are serious about preserving lives.

“I remind the nurses that I meet that I don’t take a lunch break — maybe once every six months. I’m also at work by 6.30am or 7am and leave later than most people. When people hear this, then they understand that we are in this struggle together.”

It’s the reason Sesing is enraged by ghost workers. These fake workers have bled the department’s payroll for years. The province announced in its latest budget that it had identified 225 phantom workers, and 21 people found to be involved in the scheme to steal were eventually dismissed.

“I will have no mercy for that,” she said.

Three targets

In our interview, Sesing outlined some targets for things she wishes to see improved.

Within the year, she wants accruals and other debts reduced by 30%. Accruals mean that hospitals and the department as a whole begin each financial year having to settle outstanding accounts from the previous year. Little is left over for new projects or new essential acquisitions and procurements.

Her second target is to reduce irregular expenditure by around 15%, or R300-million.

And her third target is to reduce the often hours-long waiting times at clinics and hospitals.

According to the latest Free State report from community healthcare monitoring group Ritshidze, public healthcare users in the province on average spend more than four hours waiting in a clinic queue. Some patients, it stated, arrived as early as 5.30am to be near the front of the queue, with about 81% of those surveyed saying waiting times were too long.

“People are impatient for change because things have gone wrong for a long time in the department. I understand this. But believe me, we as a collective, we are working very hard to close these gaps,” Sesing said.

‘Moving people around’

For the Democratic Alliance, the official opposition in the province, Sesing’s appointment should not have taken place while the PSC investigation into her remained open.

David Masoeu, a member of the Free State legislature and DA spokesperson for health and social development, said the ANC’s practice of cadre deployment continued to leave the door open for political meddling.

“The ANC in the Free State is known to move people around the minute they feel that that person is trying to clean house or is not acting in a way that benefits the ANC. We cannot have a case where HODs are manipulated,” said Masoeu.

He said he hoped Sesing would be open to building a better working relationship with his party, including allowing oversight work not limited to portfolio committee reports to take place.

“We know there are many problems in the Free State, so we need to be out there doing oversight. It’s the huge staff shortages across all categories and issues of infrastructure and backlogs of surgeries. Right now, the main mortuary in Bloemfontein is closed and autopsies have had to be done in Welkom. Families tell us they can wait three months to receive the bodies of their loved ones for burial,” said Masoeu.

For Brian Motshabi, the provincial secretary of the Democratic Nursing Organisation of South Africa (Denosa), Sesing’s financial qualifications were reason to be excited that the department might get its house in order.

“One of the areas that is of great concern to us is corruption and maladministration. Members tell us about problems with medical consumables that are overpriced but are of an inferior quality,” he said.

“There are also issues like renovations that are not completed but the money has already been spent. This is the case at Boitumelo Hospital in Kroonstad and the maternity ward at Pelonomi Hospital that has been going on now for more than a decade,” said Motshabi.

He said Sesing had done well on acting speedily on some issues brought to her attention, including resolving the issue of unpaid uniform allowances for nurses. But he said they were still battling to have overtime paid on time.

Also high on Denosa’s agenda was the need to employ about 1,200 clinical workers who were part of the Covid-19 supplementary staff but were not given permanent posts. The same goes for many people who were stuck in acting positions. Added to this, Motshabi said people who needed to be fired should be fired, not moved sideways or left on drawn out and costly suspensions and disciplinaries.

Motshabi said the HOD’s work in the coming months and years must remain in the spotlight because of what was at stake.

“The health department is one with a huge budget, so obviously there are those who want to get their hands on it,” he said. DM

This article was first published by Spotlight – health journalism in the public interest. Sign up to the Spotlight newsletter.

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