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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.99 n.9 Pretoria Sep. 2009




Veil of silence falls over Health department kickback probe



Chris Bateman



Protracted inaction, avoidance, broken undertakings and suspicion have greeted Izindaba attempts to report the fate of a top official in the national health department's Foreign Workforce Management Programme (FWMP) found guilty internally of taking kickbacks.

Besides confirming that Sean-Allen Smith, a pivotal player in the ongoing placement of foreign doctors and a deputy director in the national health department, was found guilty of taking kickbacks, the department failed to reply in any lucid form to questions repeatedly faxed, e-mailed and posed verbally.

This after Advocate Thomas Ngake, Director of Employee Relations, Equity and Wellness at the national health department, last July spoke breathlessly of an allegedly shady 'web' reaching into Home Affairs, the Health Professions Council and the health department's FWMP. He described the matter as 'very sensitive', with 'serious political implications' that 'involve management and beyond'.

At the time Ngake confirmed that the chief suspect was being grilled at a separate in camera internal disciplinary hearing after a forensic probe 'dating back over several years' and added that a second suspect, a security officer, was also involved.

However, a year and a host of unanswered, avoided, forgotten or tersely dismissed e-mails and phone calls later, Ngake and the communications director he referred Izindaba to, Fidel Hadebe, have fallen virtually silent.

Ngake's most recent response (29 July this year) to specific and repeatedly faxed and e-mailed questions was a terse 'fact are not correct and it is policy of the dept to make a press lease after disciplinary enquiries' [sic ].

Attempts to clarify whether he meant that it was not the policy of the department to issue press releases after disciplinary enquiries were unsuccessful.

In April this year Ngake promised, 'we will have a press conference'.

Smith came to the attention of Izindaba readers in October 2006 as a key player in an award-winning feature story about the possible impending (2008) collapse of the rural health care system because of a paucity of foreign-qualified doctors and community service doctors.1


Foreign-qualified doctors a vital cog in delivery

These two cadres form the backbone of the rural public health care delivery system. The story centred on the impact of the then new two-year internship on community service staffing while highlighting problems in recruiting and placing vital foreign doctors. The two-year internship reduced available community service conscripts by 78% last year and put rural hospitals, in particular, under immense pressure, increasing reliance on foreign-qualified doctors.

Private recruiting agencies for both doctors and nurses sang the praises of Smith in helping them cut red tape and place critically needed staff in spite of his own FWMP being severely understaffed. While some insiders viewed him as 'a bit of a loose cannon', foreign doctors cited him as the single biggest factor in their placement and ironing out of subsequent housing, subsidy and administrative problems.

He was suspended on full pay in April last year, with Ngake confirming a guilty finding by the internal inquiry in June this year, promising Izindaba more information once argument in mitigation and aggravation of sentence was completed by 20 May. He said the Director-General of Health, Thami Mseleku, would decide on the sanction.

On 27 May this year Ngake held out further hope, saying 'as soon as the (inquiry) chairperson has a draft summary I will sit with Fidel Hadebe (the departmental communications officer) and draft a press release — it won't be before the end of June'.

The questions e-mailed and faxed by Izindaba to Ngake, Hadebe and a second communications staffer, Kgomotso Phasha, on 27 July, are:

• Can I please have a copy of the committee judgement, plus the subsequent sanction? (If not, a reason and the official charge/s, verdict, and sanction.)

• Has Smith's post been re-advertised and, if not, will it be, or have his former tasks been reallocated in-house?

• Has the post been re-filled?

• What was the outcome of the concurrent criminal investigation?

• How many foreign-qualified doctors were placed in South African hospitals between the time Smith was suspended on full pay and when his internal hearing was concluded?

• How many foreign doctors were placed in South African hospitals during the equivalent period before his official suspension?

• Are there are any disparities in this comparison and, if so, can you comment on their significance when compared with foreign-doctor recruitment and placement numbers historically?


Izindaba motives questioned

In May this year Hadebe, responding to an earlier similar list of questions, promised to 'confer with Advokate Ngake on the matter', adding, 'my simple observation though, I am fascinated by the personal interest you are taking/having on this matter'.

When Izindaba located Ms Phasha on her cell phone and asked for help in facilitating a response, her parting words were, 'I'll let you know if anything comes up'.

Ngake's claim of a possible 'web' of fraudulent activity has some historical validity.

Just over 4 years ago an HPCSA official responsible for registering foreign-qualified doctors was convicted of fraud for accepting cash for improper registrations (11 doctors were subsequently struck off the roll).

Home Affairs meanwhile is replete with stories of internal fraud and corruption.

Around 15% of doctors currently working in South Africa are foreign qualified, many of them working in terms of unwieldy bureaucratic country-to-country agreements.

The global average of foreign-qualified doctors in developed countries is around 25%, but South Africa's human resource plan sets a ceiling of 5% while maintaining an 'ethical' policy of not employing foreign-qualified doctors or nurses from other African countries. Many foreign (African) doctors work as car guards in metropolitan areas around the country.

A call to the health department's FWMP established that Smith 'no longer works here — he left sometime last year'.


1. Bateman C. Rural health care delivery set to collapse. S Afr Med J 2006; 96: 1219-1226.        [ Links ]

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