South Africa

South Africa, Maverick Citizen

Eastern Cape health chief Rolene Wagner lets us in on the family secrets

IN CONVERSATION: Rolene Wagner talks with reporter Sean Christie in her childhood home in Lotus River, where her journey from competitive swimmer to healthcare innovator began. (Jay Caboz/Bhekisisa)

By Sean Christie

16 Apr 2025

In nearly 30 years in public healthcare Rolene Wagner has risen to lead an institution that many had given up on: the debt-wracked, conflict-ridden Eastern Cape department of health. Her upbringing has custom-suited her to the task.

Rolene Wagner calls the Eastern Cape home but the family seat – the house she grew up in – is in Cape Town’s Lotus River, so we made a plan to meet there, with her mother’s permission.

The pin Wagner sends lands me outside an eggshell-yellow “stop nonsense” guarding a pyramidal house on the wall of which a glazed orange street number is arranged next to a clay palm, and a sombrero-wearing donkey. Wagner comes out, high heels clacking on the brick drive, to guide the car into the paved front yard. When I open the door it’s her mother – small in stature, wearing a hibiscus-print dress – waiting to greet me.

“Cheryl,” hard “ch”. She offers a cup of coffee, and disappears.

“You know those dragon mothers,” says Wagner, nodding her head after her receding ma, “well, she’s the real deal. Vuur en vlam. There used to be a rubber tree where you’re parked, and one day us kids came back from school to find our underwear strewn in the branches for all to see – her way of telling us she was tired of picking up our clothes.”

The interior of the home is immaculate, rooms on the left, dining room and kitchen on the right, separated by a service bar. Cheryl seats me in the heart of the kitchen.

“We had a whole lot of us here yesterday, eating and playing doms (dominoes) and cards. Your father was so good with that, wasn’t he?” she says. “He could read the game so well.”

Wagner describes her mother, who devoted herself to raising three children, as “the glue holding this family together”.

Cheryl’s husband, Roland – Wagner’s father – died last year after suffering a stroke. One of the first Black systems analysts in the country, he taught IT to generations of students at Cape Technikon.

A Wagner family photograph in the photo-filled Cape Town home, includes father Roland and mother Cheryl — who, says Rolene Wagner, is "the glue holding this family together". (Photo: Jay Caboz/Bhekisisa)

“Come see the shrine, the kids won’t go in there,” says Cheryl, leading into a room with lots of family photos on the walls, and some of Roland’s effects. Wagner follows us in, sees me staring at a 50th-anniversary caricature of her mother and father, with their respective nicknames – “The Boss” and “The Coach” – on their shirts.

“My Dad coached swimming at club, provincial and national levels,” she says. “We all swam. My sister Melanie and I were national record holders for years. Mom, did Ashlyn [Wagner’s brother] make the provincial team?”

“No.”

“Table tennis was Ashlyn’s sport.”

“How do you like your coffee?”

“He coaches the national team now.”

“Straight black, no milk, no sugar.”

It’s a sonic gateau, the home’s natural condition. Wait for an opening to say something, and you might wait a long time.

I try interceding: “Were you born into this home?”

The answer is a painful “no”. The Wagners were one of many families evicted from Harfield Village after the area was declared as being for white occupation only in 1969.

“We lived opposite the Harfield station, and then we moved here,” she says.

A drive to succeed

In their new home in Lotus River, education was given an almost desperate emphasis.

“Everyone assumes it was my father who pushed this, because he was the academic, but it was Mom who took me to the library when I was two, ensuring that I could spend my childhood away on adventures with The Secret Seven or The Famous Five, far from Lotus [River] and the gangs and the shooting,” says Wagner.

She recalls being dragged by the arm between schools in the southern suburbs until one – St Augustine’s in Wynberg – offered a place.

Says Wagner: “In this house, you couldn’t do anything but be first in class, and when you were first in class, you needed to be top in your grade. And then when you were top in the grade, it was like, ‘Okay, where’s the school that all the top students go to in the province? That’s where you are going’.”

Cheryl, impassively laying out cheese rolls in front of us, says: “She was very competitive. If she didn’t win, she cried.”

“I wonder where I got that from?” Wagner retorts, and then to me, sotto voce: “She was the Western Cape sprint champion in her day. And a very good ballet dancer.”

Like so many spheres of life, education under apartheid was segregated, with separate systems for “whites”, “blacks” and “coloureds”. For outstanding students in the latter system, a place in Harold Cressy High School in the city, boasting alumni such as Rhoda Kadalie and Trevor Manuel, was very desirable. Wagner was accepted for her promise as a pianist.

“The standard of teaching was very high, partly because people of colour who had degrees couldn’t access other professions, so they went into education,” says Wagner, adding, “a lot of the teachers were highly politicised.”

Derrick Naidoo, her history teacher, was a communist with a personal history of resisting apartheid, who used to grill students over their future plans.

“He’d say: ‘Are you going to study medicine to make a lot of money, or are you going to make a difference?’” Wagner recalls.

Training for success

She and her fellow students participated fully in the schools’ boycott of 1985 in the Western Cape, repeating the year to signify disdain for the system. For Wagner, whose life had been measured out in academic awards, the sudden rupture led her to focus more fully on swimming.

“We trained twice a day, before school and again after school from six till eight, which was when public swimming pools used to shut.”

“We didn’t train to win, we trained to break records.”

Roland Wagner, who coached swimming for dozens of years, coaching his grandson, Philip. (Photo: Rolene Wagner)

Roland Wagner was both father and coach, the roles blurring at times. Feeling that standards at the local swimming club were lacking, he had read up about scientific ways of swimming, like training your VO2 max, and lactic acid tolerance. The small team he coached was soon dominating at galas.

The mention of her late husband brings Cheryl back into the kitchen.

“When your father died there were over 400 people in the church, another 500 online. There were generations of swimmers that turned out.”

As much as he pushed his children in the swimming pool, it was Roland Wagner’s great hope that his daughter Rolene would study medicine and become a doctor. When she graduated from the University of Cape Town’s medical school in 1996, he hugged her and said: “Now you can do what you want.” Wagner recalls these words with a sobbing laugh.

“I think what he meant was that it hardly mattered what else I did with my life after that, as far as he was concerned I’d achieved something that he was proud of. That released me.”

A penchant for public health

Wagner worked in the Mitchells Plain Community Health Centre, formerly known as the day hospital, for three years, and it was here that an interest in public health was sparked.

Wagner explains: “In 1996 South Africa had introduced the Choice on Termination of Pregnancy Act, but procedures were mainly available in large hospitals, and only at 12 weeks. The process required two full days, meaning that parents of younger clients were bound to find out. For many, this would have been a reason not to proceed.”

Wagner, who had been seeing patients at six to eight weeks, proposed to her superintendent that she be allowed to conduct procedures at the community health centre instead of at the hospital, where there was a long waiting list, and that she be allowed to visit all the other day hospitals in the area, to train doctors to do what she was doing.

“You know what my superintendent said, rest his soul? He said: ‘Your job is to see 45 patients a day, that’s it.’ I couldn’t believe it. Anyone can see 45 patients a day. I’m talking about amplifying what we’re doing, so that many more can benefit. He couldn’t see it.”

Wagner’s frustration drove her to check newspaper classifieds, where she spotted a job in health management with the Western Cape health department.

“I jumped straight in my car and drove to the head office, only to be told that without management qualifications I stood no chance. So I got back in the car and drove to the University of Cape Town’s medical school, and asked if I could enrol in their newly launched public health programme. They accepted my application, and I’ve never looked back.”

Building systems is in her blood

As her training progressed, Wagner inclined towards health information systems. For her thesis she designed and rolled out a vitamin A programme, to lower the risk of death from childhood infections such as measles. She did this in collaboration with her father, who travelled with her in the capacity of technical expert.

She smiles. “That was cool.”

Wagner is known for her use of health information systems today, not least those she and her team implemented in East London’s Frere Hospital after she was appointed CEO in late 2012. Frere, at the time, had a deserved reputation of being the place where babies go to die. Wagner set about stabilising the hospital, and a major part of her turnaround strategy, which was recognised with an award from the International Hospital Federation in 2018, was the design of an electronic patient record system, or hospital management system (HMS).

“We designed and developed it while I was at Frere but wanted to create something that would be useful more widely in the developing world,” says Wagner, who, as the current superintendent general of the Eastern Cape health department, has overseen the roll-out of an evolved version of the system, HMS2, in 40 hospitals.

As word of its efficacy spread, others have become interested: the Free State health department is already using HMS2 in 14 of its hospitals, and the Department of Health has asked the Council for Scientific and Industrial Research to assess the system for scalability.

Adversity

“Shoot, mom, are you okay?”

Cheryl’s back seizes up as she’s on her way out of the kitchen. In a second Wagner is off her seat and at her mother’s side, trying to get her to lie down. Cheryl dismisses the concern.

“I’ve fractured my spine three times. I’ve had a lot of things – the doctor tells me I’m a cat with 94 lives.”

Rolene Wagner with her mother, Cheryl, who raised three kids in their Lotus River home in Cape Town, on a beach day. (Rolene Wagner/Bhekisisa)

Wagner has had her own share of adversity. She moved to the Eastern Cape in 1999 with her then-husband and their 10-week-old twin daughters. It wasn’t long before her marriage ended, and she was caring for the girls on her own. One of the twins, Laura, had a neural tube defect and required several lifesaving surgeries.

Wagner’s coping tactic was to “go home, switch off the lights, lie down and calmly wait”.

“It started before she was born, when every new scan revealed more things wrong with her. At a point I asked myself: ‘Why are you mourning for a child that hasn’t died?’ Better to celebrate, and if something happens, deal with it then.”

Laura, now 26, is a programme manager for a thriving media company. She is also a part-time model, fashion designer and motivational speaker, telling her story of defying medical expectations, and realising goals people told her were too lofty for a person with a disability. Emma, Laura’s sister, was admitted as an attorney in February. Wagner’s recently matriculated son, Philip, is a national water polo player.

A major part of Rolene Wagner’s life is her big family, who have inspired and supported her throughout her professional and personal life. (Rolene Wagner/Bhekisisa)

Wagner’s approach to life’s challenges marries the dual influences of her mother and father.

“During a strike that happened when I was at Frere Hospital, I had my mother calling asking ‘Are you safe?’ and my father, the socialist, would come on the line and say ‘Have you paid your workers? Have you solved their problems?’

My dad was extremely principled. He walked out on a job with no other prospects because he couldn’t abide racism in the workplace. My mom balances, she will say: ‘Yes, be principled but don’t cut your nose to spite your face. How about building relations?’”

Stabilising the system

Wagner has worked in the private sector – running a general practitioners practice with Medicross, and as the medical director of Netcare’s primary care division (2019 to 2021) – but these stints confirmed that public healthcare was the place for her.

“If a private sector facility consistently makes a loss it will be closed, but we don’t have that mandate. We must still provide the services, and must do so in the context of shrinking budgets. To do this we have to be social entrepreneurs, and that’s what I love about the space we’re in. It’s about building social capital through the work that we do.”

The position of superintendent-general of the Eastern Cape health department was advertised in the middle of the Covid-19 pandemic. Wagner, who was working in Johannesburg with Netcare, “took a leap of faith” and applied. After being appointed, she took control of a department on the verge of collapse.

Out in the field with ‘my beloved‘ Eastern Cape department of health team in December of 2024. (Rolene Wagner/Bhekisisa)

“The first six months were all about stabilising the organisation,” she says. Budgets were reprioritised, and controls were implemented, including a roll-out of HMS2. By the end of 2022/23 there was some measurable improvement: irregular expenditure, which had been at R156.5-million in 2020/21, was down to R6.8-million, The department’s steeply rising debt trajectory had levelled off, and, thanks to precedent set by a February 2023 ruling in the Eastern Cape High Court, the department’s medico-legal bill dropped by 65% between 2017-18 and 2023-24. Judge Robert Griffiths ruled that the common law must be developed so that the state will not have to pay the future medical expenses of patients harmed through negligence as a lump sum, instead offering treatment in state facilities.

“That judgment is now being tested at the Supreme Court of Appeal, and if it is upheld, it won’t just benefit us in the Eastern Cape, it will be the entire health sector that the law will apply to. Winner!” says Wagner. “And then I left.”

In a move that scandalised the public healthcare community, Wagner was shuffled into the Office of the Premier by Eastern Cape premier Oscar Mabuyane. She was one of four heads of departments removed from office in this way, in murky circumstances. In an article in Spotlight, Alex van den Heever, the chair of social security systems administration and management studies at the Wits school of governance, was quoted as saying: “To me, it sounds like they removed the accounting officer and replaced them with an acting person to manipulate contracts, tenders, procurements and appointments.” That was a widely held theory in the medical community at the time.

Wagner alone was returned to her role in August 2024. It would be impolitic for her to dwell on the fiasco, and she doesn’t – she says, instead, that the workings of life are mysterious.

Finding balance in a binary life

“In that year my father had a stroke, my mother had serious health issues and my kids needed some extra support. Thanks to what happened, I was able to be there for them,” she says. There was also time for introspection.

“After my father died I realised that I had been leading a binary existence for years, with family on the one side, work on the other, and nothing in between. Among other things, I had been completely ignoring my own risk factors.”

Wagner – a university track star – hauled out a treadmill she had used four times in four years, and started running fartleks over 3km. She watched what she ate and dropped 8kg. When she received the call to return to the head of department role, Wagner wanted to be sure she was up to the task. She took a drive down to East London’s Nahoon Beach.

“I remember it was sunset, and it was quiet. Being August, there was that cool saltiness to the air. I knew if I was going to lead others I had to start in a good space, with no recriminations about what had transpired. I took a deep breath and felt re-energised and recentred – all pistons firing. I thought, okay, it’s a fresh start, everybody has an opportunity to be part of this journey. Let’s go.”

Rolene Wagner talks with reporter Sean Christie in her childhood home in Lotus River, where her journey from competitive swimmer to healthcare innovator began. (Jay Caboz / Bhekisisa)

Wagner will need every iota of renewed energy to arrest the department’s slide into dysfunction. Departmental debt ballooned in her absence.

Every week brings its own clutch of negative headlines, and belief in Wagner’s ability to turn things around has undoubtedly waned. Ben Gaunt, the former CEO of Zithulele Hospital (and now no longer an employee of the Eastern Cape department of health, after he applied successfully for constructive dismissal) puts it to me like this: “There’s no question she’s the right person for the job – she has the rare ability to see both the bigger picture and work in the grain of short-term solutions – but she works in a very unconstructive environment, where truly strong leaders aren’t necessarily welcome.”

Wagner’s phone rings, and she doesn’t have the luxury of keeping it downturned. It’s Philip, her son, they had planned to meet at the mall, with the twins. Time to go, and Cheryl leads the way. She remembers everything I’ve said about my personal life and spins it into a meaningful farewell.

“As a family we are lucky to have her – we were lucky to have both of them,” says Wagner. Driving away, a similar thought occurs. Us too, Rolene. DM

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.

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