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SAMJ: South African Medical Journal

On-line version ISSN 2078-5135
Print version ISSN 0256-9574

SAMJ, S. Afr. med. j. vol.98 n.6 Pretoria Jun. 2008




Creeping mediocrity in public governance threatens the public health



It is common cause that, for a complex set of reasons including inexperience, incompetence, corruption and the sustained loss of skilled person-power, the quality of service provision by government departments, municipalities and other local authorities has been in steady decline in recent years. There has also been a disturbing erosion of the service ethic even among professionals like nurses and teachers in the public employ. The recent report of a woman forced to deliver unattended in a vehicle in a hospital parking lot because the nurses would not come to her aid, and whose newborn baby subsequently died, is just one example of the pervasive culture of indifference and uncaring attitude in the public service, in direct contradiction to the national slogan of 'Batho Pele - People First'.

This creeping mediocrity in public governance and service constitutes a direct threat to the public health, and nowhere is this better illustrated than in the failures relating to the management of drinking water, sewage and electric power that have already cost lives.

Infrastructure obsolescence, neglect and lack of skilled maintenance have led to the deterioration and even total breakdown of sewage treatment plants in many municipalities, as a result of which leakage or - in some instances - the deliberate disposal of raw sewage directly into rivers and other fresh water sources has resulted in the growing problem of faecal contamination of fresh water sources and even beaches around the country. One such leak occurred in Durban recently, where witnesses described a culvert, normally home to a nursery of small eels and fish, as being 'transformed into a stinking cesspool as used toilet paper, condoms and raw sewage rushed down it'. Recently Durban's famous beaches lost their Blue Flag international rating because of unacceptable levels of microbial contamination. Water purification and reticulation systems are plagued by the same sort of challenges in many jurisdictions.

Elsewhere in this issue we report on the baby deaths in the Eastern Cape as a result of water pollution, but this province is not unique in this respect. High E. coli counts in drinking water have been confirmed at other locations across the country. According to one report, sewage contamination in the Free State town of Rouxville's drinking water was confirmed as the cause of a gastro-enteritis epidemic in which at least two people died. A test on a water sample taken at the town hall at the time of the epidemic showed a coliform bacteria count of 48 per 100 ml and an E. coli count of 21 per 100 ml. The maximum level for coliforms in safe drinking water is 5 per 100 ml and zero for E. coli.

The Department of Water Affairs and Forestry identifies inappropriate land subdivisions, inappropriate township establishments and the mushrooming of informal settlements situated next to rivers as posing a high pollution risk to ground water resources.

Something rotten in the Kingdom of KwaZulu

Members of the Durban City Council recently became alarmed and distressed when foul-smelling air inundated City Hall chambers and offices. The mysterious stench was eventually tracked back to decomposing unrefrigerated corpses stacked up on one another at illegal funeral parlours in the surrounds. Durban has a huge problem of ill-equipped and unlicensed funeral undertaker businesses, estimated at up to 250 in the city alone, when only 150 legitimate funeral homes are registered throughout the province of KwaZulu-Natal.

The rogue parlours have inadequate refrigeration facilities, a situation made even worse by load shedding power outages. These outfits cause further environmental contamination by flushing bodily fluids down storm-water drains. A former home affairs official reminds us that 'They can't even register deaths because they don't have registrars of deaths'. So much for our national mortality statistics.

Funeral undertaking has become big business in South Africa generally and in KZN in particular, fuelled in large part by the ballooning number of deaths from the HIV/AIDS pandemic and from interpersonal violence. The Durban City Hall stench is a poignant culmination of spectacular failures in public governance: the denialism and prevarication that allowed the HIV/AIDS epidemic to get out of hand, the failure of municipal government to anticipate and plan for the well-predicted explosion in HIV/AIDS mortality, and the incapacity of the city effectively to regulate and monitor the funeral undertaker industry. The report of a municipal investigation unit to the city's Health, Safety and Social Services Committee reportedly concedes that the situation is out of control and beyond the city's capacity to manage all on its own. The consequence of all this is not only indignity to the deceased, but a real threat to the public health.

There is an obligation for civil society to expose governance failures that inflict illness and death upon the country's own citizens, and an urgent need for government to take the necessary steps to combat mediocrity and decay in the public service.



Daniel J Ncayiyana

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