Nomantu Nkomo-Ralehoko’s comeback as Gauteng health MEC sparks mixed reactions

8 Jul 2024

ANC support in Gauteng dipped below 40% in the recent provincial elections and an ANC-led minority government is now at the helm. Among those in premier Panyaza Lesufi’s new Cabinet is Nomantu Nkomo-Ralehoko who has been reappointed as MEC for health and wellness.

Nomantu Nkomo-Ralehoko was first appointed Gauteng’s MEC for health and wellness in October 2022. A long-time ANC member, she previously served as MEC for finance and e-government and has been a member of the provincial legislature since 1999.

She returns to the critical role at a time when the province’s health department, based on extensive reporting by Spotlight and other publications, remains mired in a chronic cycle of administrative and service delivery dysfunction.

At just under R65-billion for the current financial year, the department gets a huge slice of the Gauteng budget. While the National Department of Health leads on health policy, the day-to-day running of public healthcare services is managed by provincial departments of health.

The Gauteng health department has a large number of vacancies. On the administrative side this includes the critical position of chief financial officer (CFO). The previous CFO, Lerato Madyo, was suspended in August 2022. Her case is still to be concluded. Research conducted in 2023 by community healthcare monitoring group Ritshidze found that the majority of healthcare facility staff and public healthcare users they surveyed felt that healthcare facilities were understaffed.

Madyo’s case is connected to ongoing investigations by the Special Investigating Unit into corruption at Tembisa Hospital. This was also the issue that whistle-blower Babita Deokaran was investigating before she was assassinated in August 2021. Deokaran was acting chief finance director before she was killed. Since her death it’s been confirmed that there was corrupt spending to the tune of R1-billion at Tembisa Hospital.

When Nkomo-Ralehoko answered 10 questions from Spotlight shortly after her appointment in 2022: she said that “one of my immediate focus areas is to ensure that the department’s systems across delivery areas such as Finance, Human Resources, Monitoring and Evaluation, Risk Management, etc are strengthened so that processes are not dependent on human vulnerability but there are clear checks and balances. An environment that has no consequence management breeds ill-discipline and a culture of ignoring processes and procedures as prescribed in our legislative framework.”

Gauteng also faces mounting surgery and oncology treatment backlogs. Its clunky supply chains and procurement systems have often left suppliers unpaid and facilities struggling without basic medical consumables, as well as not being able to procure large pieces of equipment when needed. Some hospitals have had periods when patients have had to go without food.

Questions remain about governance capacity in the department. Notable examples from Nkomo-Ralehoko’s tenure so far include inaction over using a March 2023 Gauteng treasury allocation of R784-million for outsourcing radiation oncology services. These ring-fenced funds were secured following sustained pressure and protests by activists and civil society. This money has still not been spent.

The department is also still to implement a June 2022 memorandum of agreement with the University of the Witwatersrand. The agreement sets a framework for the department and the university to mutually address many of the health sector challenges in the province, while ensuring the academic training of the next generation of doctors takes place.

Another key challenge for Nkomo-Ralehoko will be how to navigate a changed Gauteng legislature in this seventh administration. There is no outright majority and there is no unity government deal that includes the largest opposition party, the DA. This will represent distinct hurdles for passing budgets or garnering enough votes for approvals in the house.

Despite these challenges, the reappointment of 58-year-old Nkomo-Ralehoko is being welcomed by some. They say she brings stability to a portfolio that has been plagued by shaky, short-lived tenures in the top role. They say she has a flexible leadership style, and that she is open to working with many different stakeholders. But her critics charge that she cannot deliver the overhaul that the department needs and that she has not been tough enough on corruption.

‘More of the same’

Jack Bloom, the DA’s health spokesperson in Gauteng, says: “I don’t think the present MEC deserves to be reappointed, but that’s for the ruling party to determine. What we will get going forward is more of the same. The Gauteng Department of Health needs wholesale change but it’s not going to happen under the present situation.”

Bloom says Nkomo-Ralehoko’s comeback is “cadre deployment and political protection”, adding: “I’m afraid that the corruption is across the board and the looting is going to continue.”

He says the MEC slow-walked disciplinary action on many suspended senior staffers and has also failed to tighten up on the likes of pre-employment checks on would-be employees, resulting, he says, in weak candidates being appointed.

The EFF is the third-largest party in the Gauteng legislature. Nkululeko Dunga was contacted to weigh in on Nkomo-Ralehoko’s reappointment but he declined to take our calls and didn’t respond to written questions.

‘Delays that cost lives’

Speaking briefly to news channel eNCA after she signed her oath of office on 3 July, Nkomo-Ralehoko mentioned oncology and radiation services as one of her priority areas. She referred specifically to the building of bunker-like facilities to house specialist cancer treatment equipment procured for Chris Hani Baragwanath and George Mukhari hospitals.

However, for Salome Meyer of the Cancer Alliance, the fact that equipment has been procured but is sitting in storage amounts to delays that cost lives. She says there are currently 3,000 patients in the province on waiting lists for cancer treatment.

“Our facilities are operational but they aren’t operating at full capacity because the equipment is not in use or we don’t have staff to operate the equipment,” Meyer says.

“What we’re seeing is resignation after resignation of radiation therapists because they aren’t on the correct pay grade. So, even when we do get equipment there are not enough people to operate the equipment,” she says.

“The MEC has to start looking after her own people – the people who work in our clinics and hospitals.”

Meyer also flags the problem of a lack of communication between the Cancer Alliance and Nkomo-Ralehoko and her department.

“There is no relationship between the MEC and the Cancer Alliance. We had set up a dedicated task team to ensure that we had open communication with the Gauteng Department of Health, but communication has just come to a halt,” she says.

‘Ensuring stability’

For the Democratic Nursing Organisation of South Africa (Denosa) in Gauteng though, Nkomo-Ralehoko has used her 20 months in the MEC role so far to start making the right turnarounds for the health department.

The association’s Bongani Mazibuko says: “We believe that this welcome appointment of the MEC will go a long way in ensuring that there’s stability in the department and it’s something that Denosa has long been calling for.”

Lack of stability has been a feature of Gauteng health over the past decade or so. When Nkomo-Ralehoko was appointed in 2022, she replaced Nomathemba Mokgethi, who had been in the job for under two years. Before Mokgethi, Bandile Masuku too was in the position for fewer than two years. Gwen Ramokgopa filled in for a bit more than two years, and before her, Qedani Mahlangu was forced to resign after the Life Esidimeni tragedy.

Denosa in Gauteng has also called for the finalisation of CEO appointments and for senior management posts to be filled, and says fixing of infrastructure is critical “so that the department can be more functional”.

Mazibuko adds: “We need to ensure that appointment of nurses is prioritised as they are the backbone of the system. But we have faith that we can continue working together to ensure that the people of Gauteng get the health that they deserve.”

Right direction, but needs to act on corruption

Treatment Action Campaign Gauteng chairperson Monwabisi Mbasa also supports Nkomo-Ralehoko’s reappointment. He says that compared with her predecessors, Nkomo-Ralehoko has so far been someone they feel they can work with.

“We have seen that in the past nearly two years the MEC has been trying to address some issues plaguing public healthcare at provincial, district and clinic level. She is hands-on and flexible, so we have confidence in her still,” he says.

But Mbasa adds that she must be held to account for not taking “drastic action against corruption”. He says 26 of Gauteng’s 37 public hospitals have in recent times run out of food but Nkomo-Ralehoko’s intervention included using suppliers and service providers who were not properly registered. He says it is a red flag and they will continue to hold the MEC to account.

Mbasa says that moving health forward in the province will require alignment of the health department with the departments of infrastructure and development and of finance.

“Infrastructure of our health facilities is an emergency. We are also calling for the improvement of supply chain management and procurement of goods and services and we need to improve human resources.

“There are challenges and weaknesses in the Cabinet but it’s good that we are not working with completely new people in these portfolios. This is the time to accelerate and to ensure that we use the seventh administration to improve the delivery of public health.”

After long and tense talks, negotiations with the DA to form part of the provincial executive deadlocked. This resulted in premier Panyaza Lesufi naming a Cabinet with seven MEC positions for the ANC and one each to the PA, IFP and Rise Mzansi. DM

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

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Maverick Citizen

‘More of the same’

‘Delays that cost lives’

‘Ensuring stability’

Right direction, but needs to act on corruption