State failure shall not be framed as NGO failure: The anatomy of a healthcare atrocity in South Africa
By Péter MARTON
Have you heard of the Life Esidimeni healthcare scandal before? In a nutshell: There is pressure now on the managers of several South African NGOs to account for the deaths of psychiatric patients in their care after as many as 75 patients died in the facilities of five of these organisations between March 23 and December 19, 2016, in Gauteng Province (population: 12.2 million). A total of 141 deaths (including at hospitals) are being investigated. So who is responsible for these deaths?
South African Health Ombudsman Dr. Malegapuru Makgoba named five NGOs "the most dangerous" related to the cases concerned. These are Precious Angels, CCRC/Siyadabinga/Anchor, Mosego/Takalani, Tshepong, and Hephzibah (see page 1 of this government report for the list and more).
These and 22 other NGOs took over mental patients from Life Esidimeni, the healthcare contractor that provided services up to 2015 for the Department of Health in Gauteng province. The Department of Health terminated its contract with Life Esidimeni statedly to "de-institutionalise" patients and, admittedly, to save money.
And then the deaths came, and it also turned out that all of the NGO substitutes worked under invalid licenses.
It is wrong to blame the consequences on the "NGOs" in general. Rather than an NGO failure, what happened here was no less than state failure in the first place.
In the process of "de-institutionalising" 2,000 patients to hospitals, NGOs and families, the authorities were warned by at least three NGOs of the risks of the policy. These include NGO Section 27 (campaigning under Article 27 of the South African Constitution, i.e. for the right to healthcare services), as well as the South African Society of Psychiatrists (SASOP) and the South African Depression and Anxiety Group (SADAG).
The word "de-institutionalisation," clearly intended to be an euphemism in this context, speaks volumes about what went wrong here. The state retreated: the production of an institutionally provided public good was decreased, families were burdened, and some of the people concerned were simply abandoned to their fate (pushed out of the institutional frameworks, into the wild) through the negligent licensing and oversight of NGO activities. This, so that a public health institution could in turn shrink in size, and money could be saved related to this.
NGOisation in the worst sense.
Speaking with more general significance, healthcare spending trends show major divergence worldwide, and it is often in low or middle income countries that spending is persistently low or may be on the decrease, resulting in major gaps in health outcomes. Gaps between the non- or de-institutionalised and those well-institutionalised... (Note: South Africa is "upper middle income," but with great internal disparities, manifest also in the public-private distribution of healthcare burdens.)
This doesn't bode very well looking ahead to the rising public health challenges of the 21st century, in an interconnected world with increasing population concentration...
To conclude with, here's a WHO statistic (2009) on the correlation between health spending and GDP per capita, connecting back to the picture I used for the post above, although to say that "wealth is health" may be just as empirically relevant as "health is wealth."
Have you heard of the Life Esidimeni healthcare scandal before? In a nutshell: There is pressure now on the managers of several South African NGOs to account for the deaths of psychiatric patients in their care after as many as 75 patients died in the facilities of five of these organisations between March 23 and December 19, 2016, in Gauteng Province (population: 12.2 million). A total of 141 deaths (including at hospitals) are being investigated. So who is responsible for these deaths?
South African Health Ombudsman Dr. Malegapuru Makgoba named five NGOs "the most dangerous" related to the cases concerned. These are Precious Angels, CCRC/Siyadabinga/Anchor, Mosego/Takalani, Tshepong, and Hephzibah (see page 1 of this government report for the list and more).
These and 22 other NGOs took over mental patients from Life Esidimeni, the healthcare contractor that provided services up to 2015 for the Department of Health in Gauteng province. The Department of Health terminated its contract with Life Esidimeni statedly to "de-institutionalise" patients and, admittedly, to save money.
And then the deaths came, and it also turned out that all of the NGO substitutes worked under invalid licenses.
It is wrong to blame the consequences on the "NGOs" in general. Rather than an NGO failure, what happened here was no less than state failure in the first place.
In the process of "de-institutionalising" 2,000 patients to hospitals, NGOs and families, the authorities were warned by at least three NGOs of the risks of the policy. These include NGO Section 27 (campaigning under Article 27 of the South African Constitution, i.e. for the right to healthcare services), as well as the South African Society of Psychiatrists (SASOP) and the South African Depression and Anxiety Group (SADAG).
The word "de-institutionalisation," clearly intended to be an euphemism in this context, speaks volumes about what went wrong here. The state retreated: the production of an institutionally provided public good was decreased, families were burdened, and some of the people concerned were simply abandoned to their fate (pushed out of the institutional frameworks, into the wild) through the negligent licensing and oversight of NGO activities. This, so that a public health institution could in turn shrink in size, and money could be saved related to this.
NGOisation in the worst sense.
Speaking with more general significance, healthcare spending trends show major divergence worldwide, and it is often in low or middle income countries that spending is persistently low or may be on the decrease, resulting in major gaps in health outcomes. Gaps between the non- or de-institutionalised and those well-institutionalised... (Note: South Africa is "upper middle income," but with great internal disparities, manifest also in the public-private distribution of healthcare burdens.)
This doesn't bode very well looking ahead to the rising public health challenges of the 21st century, in an interconnected world with increasing population concentration...
To conclude with, here's a WHO statistic (2009) on the correlation between health spending and GDP per capita, connecting back to the picture I used for the post above, although to say that "wealth is health" may be just as empirically relevant as "health is wealth."
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