Premier Ntuli demands accountability amidst KZN's government crisis
Image: Supplied
IN A BID to get his KwaZulu-Natal's provincial government in order, Premier Thamsanqa Ntuli has called for accountability from his MECs amid the struggles of the Department of Health and the limping-along Department of Education.
Ntuli held a marathon media briefing with all members of the Provincial Executive Council (MECs) present, following its normal cabinet meeting in Pietermaritzburg on Wednesday.
The briefing came as the KwaZulu-Natal Health Department, led by MEC Nomagugu Simelane-Mngadi, faced a financial crisis, having racked up an alarming R1.7 billion debt to service providers.
As a result, several key health projects had to be halted, leading to a protest outside the provincial headquarters in Pietermaritzburg on Monday. The angry service providers blocked the entrance, demanding their overdue payments.'
Ntuli condemned the actions of the protestors, saying, 'We also wish to condemn the barricading of the offices of the Department of Health by disgruntled service providers, on Monday. No dispute, however large, should be resolved through violence in KwaZulu-Natal. We live in a constitutional democracy and we must always use legal avenues to settle our disagreements.'
Simelane-Mngadi, while addressing the matter, confirmed the R1.7 billion debt and explained that the department was cutting back on certain projects to free up funds to pay service providers.
'We are dealing with the issue, and we will cut some projects and divert the saved funds toward payments to service providers,' she said. She also mentioned that negotiations were underway with service providers, including those with monthly payments over R500,000, to spread their invoices over two months.
The department's financial difficulties have caused significant disruptions to health services across the province, with several service providers halting operations due to unpaid invoices.
On the National School Nutrition Programme (NSNP), which had more than 1700 services, Ntuli said the 22% unpaid service providers of the NSNP, under the education department, would receive their payments on Friday, May 9.
'We are pleased to report that on April 24, 2025, at least 78% of the payments had been successfully processed. Attempts to finalise the remaining payments on April 25 and May 2 were unsuccessful. This was due to technical difficulties linked to the new financial system, BAS Version 6, said Ntuli.
The department of education was also battling increased controversy stemming from the non-payment of Grade R teachers in KZN.
The Daily News' report, this week, highlighted their plight after they were not paid their April salaries. Many teachers, including Nondumiso Ngcobo, a Grade R teacher at Motala Primary School in Pinetown, said the non-payment has plunged her finances into disarray.
Education MEC Sipho Hlomuka said: 'It is not true that some teachers won't be paid. In terms of the educators for Grade 1, there was a challenge because, we unfortunately did not renew their contracts in time. But they have been paid."
He added: "We are human beings and we make mistakes."
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Its health department regularly struggles with accruals and paying suppliers on time. Given all these challenges, it is puzzling that these two provinces in particular are so committed to sending students to Cuba, at what we understand to be higher cost than for training doctors locally. 'Better investments' Professor Lionel Green-Thompson, now the dean of the faculty of health sciences at the University of Cape Town, was involved in managing returning students from the Cuba-SA programme between the mid-2000s and 2016. At the time, he was a medical educator and clinician at Wits University, where he oversaw the 18-month clinical training of more than 30 returning students. 'Some of these students were among the best doctors that I've trained, and I remain a stalwart supporter of the ideals of the programme. But at this point, there are better investments to be made, including directly funding university training programmes in South Africa,' he said. 'A programme that's rooted in our nostalgic connection with Cuba and its role in our change as a country is now out of step with many of the healthcare settings and realities we face in South Africa,' said Green-Thompson. He added that a proper evaluation of the programme needed to be conducted. There were also lessons to learn, he said, including a review of admissions programmes. How some students who entered a programme at 20% below the normally accepted marks and exited the programme as excellent doctors, offered clues on how great doctors could be made, he said. Green-Thompson also suggested that we needed to ask why specialisation had become a measure of success for many doctors in South Africa, often at the expense of family medicine. This, he said, took away from the impact doctors made at the community healthcare level as expert generalists. But changing the perspectives of healthcare professionals required early and sustained exposure to working in community healthcare settings, said Professor Richard Cooke, the head of the department of family medicine and primary care at Wits. Cooke is also the director of the Wits Nelson Mandela-Fidel Castro Collaboration since 2018 and serves on the Nelson Mandela-Fidel Castro Ministerial Task Team. 'I'm not in support of further students being sent to Cuba for the undergraduate programme, because these students are not being trained in our clinical settings,' he said, speaking in his Wits capacity. 'The Cuban system is far more primary healthcare based than South Africa's, but that doesn't necessarily translate into these students ending in primary healthcare,' said Cooke. And curricula at Wits were shifting, for instance, towards placing students at district hospitals for longer periods of time, rather than weeks-long rotations, he said. 'When students become part of the furniture at a hospital, they become better at facilitating, at critical thinking, problem solving, teamwork and collaboration,' Cooke said. But making this kind of transformation in local training took government funding and commitment. Students and doctors needed to be attracted to the programme and needed reasons to stay. But the money and resources to make this happen were simply not there — even as the Cuba training programme continued. Cooke added: 'There hasn't been definitive data on the Nelson Mandela-Fidel Castro programme. But even if the programme over 30 years has done well and met its targets, it's not been cost efficient. What's needed now is to leverage expertise and establish partnerships in different, more cost-effective ways like in research, health systems science and health science education.' Up to three times more expensive? Professor Shabir Madhi, the dean of the faculty of health sciences at Wits, said the Nelson Mandela-Fidel Castro programme costs an estimated three times more than it cost to train a student in South Africa. This, he said, should be enough reason for a beleaguered health department like Gauteng's to stop sending students to Cuba. He added: 'The government is aware that it simply can't absorb the number of medical graduates being produced.' Madhi says some trainee doctors were sitting at home while others trying to finish specialisations were being derailed. Broadly, he pinned the blame on the mismanagement of resources, including the department underspending R590-million on the National Tertiary Service Grant meant to subsidise specialised medical treatment at tertiary hospitals. Madhi said universities had worked hard to close the gaps identified by the Nelson Mandela-Fidel Castro programme 30 years ago, but now student doctors were being let down by the government not playing its part. 'Across the universities, there's been a complete overhaul of the curriculum to be focused on primary healthcare. Students are also getting community exposure as early as first-year training,' he said. He added that when it came to admissions, the majority of students entering medical schools across the country were now black South Africans, and additional changes had been made to the selection process. 'We used to have a race quota, but in further revisions we have introduced criteria that focus on the socioeconomic component, with 40% of the admissions coming from students in quintile 1, 2 and 3 schools [no-fee public schools],' he said. South Africa had 11 medical schools, with the most recent addition being North West University — specifically focused on rural health — and the University of Johannesburg in the pipeline to join the list. So the number of doctors being trained and graduating was increasing. Madhi estimated that the total number being trained was above 900 per year for Gauteng alone. The bottleneck of getting doctors into clinics and hospitals, he maintained, was not a shortage of doctors, but the government's inability to pay doctors' salaries or to create functioning, well-resourced workplace environments. 'You can't put a price on that' For Dr Sanele Madela, the ongoing challenges could not detract from the goal to get doctors into communities — including through the Nelson Mandela-Fidel Castro programme. Today, he is the health attaché at the Havana Mission for the Nelson Mandela-Fidel Castro training programme. Madela was also at one time a schoolboy with a dream of becoming a doctor. Growing up in Dundee in KwaZulu-Natal, he remembers almost never seeing a doctor in his community. 'Then when we did see a doctor, it was a white person or an Indian person and they never spoke our language — a nurse would have to translate,' said Madela, who was part of the 2002 Nelson Mandela-Fidel Castro intake. The six years abroad, he said, exposed him to very different reasons for becoming a doctor. 'When people finish medical school, they say thank God it's over, but in Cuba people say thank God for the knowledge and information so they can give back to their country,' he said. When Madela got back to South Africa, his journey eventually led him to work in Dundee district hospital. It was the same hospital where his mother had worked as a cleaner. The Nelson Mandela-Fidel Castro programme, Madela said, still played a vital role because of its objective to get more doctors into rural and township areas — 'and you can't put a price on that'. 'We are used to seeing the Nelson Mandela-Fidel Castro programme from the point of view of adding human resources, but it's also about the impact it makes for a community,' he said. It's the impact of a community finally getting their own doctor. His argument is that, thanks to the Nelson Mandela-Fidel Castro programme, he got to be that person for his community. DM
