What is it like to be a health minister?

ANTHONY BUTLER: Mkhize’s new affliction adds grief to a chronically unhealthy department


Spare a thought for beleaguered health minister Zweli Mkhize. It has been a bad year for health ministers around the world. In truth, however, it is never a political blessing to hold this dismal portfolio.

Health ministers everywhere find themselves curiously powerless at the best of times. Unable to divert resources from expensive and ineffectual treatment programmes to the prevention initiatives that are the real route to a flourishing population, they are condemned to be ministers of illness rather than of health.

The drivers of illness lie far beyond their portfolio’s reach. When ordinary people have decent work, nutritious food and shelter, they are robust. When they are properly educated, they know how to look after their own health and that of their families.

Other ministers hold the real levers of power. Death and injury, for example, can justly be laid at the doors of our ministers for transport and policing. Without public transport in rural areas poor people cannot even reach the best of clinics. The long commutes of the apartheid city bring obesity and cardiovascular disease.

Expensive hospital beds are choked with the elderly, who should be cared for in social protection programmes. Murky water kills our young children. The indoor burning of coal and wood ruins lungs, while paraffin stoves cause serious burns; both are the products of disastrous energy policies.

Can any health minister tell ordinary citizens to stop indulging their cravings for sex, alcohol and tobacco? It is surely likewise prudent not to walk across the moral minefields of contraception or abortion.

The benefits of good public health are spread too diffusely to be noticed, and ordinary people will not credit the minister for realising them. Meanwhile, powerful groups such as hospitals, insurers, drug companies and unions will frustrate any residual potential for benevolent change.

Now Covid-19 has made things immeasurably worse. Last week 54 Commonwealth health ministers pointed to the suspension of pre-existing immunisation campaigns, the collapse of many essential health services, and the erosion of programmes to combat malaria, HIV/Aids and noncommunicable diseases.

Tunisia has had three health ministers in a year, and the Czech Republic four in eight months. In the UK, by contrast, health secretary Matt Hancock seemed to be basking in the glow of public adulation as a result of the successful unrolling of a national vaccination programme.

Then on Wednesday Dominic Cummings, a former senior aide to prime minister Boris Johnson, told a parliamentary committee that “tens of thousands of people … who didn’t need to die” had perished needlessly during that country’s Covid-19 epidemic. He laid much of the blame at Hancock’s door, describing the minister as a serial liar and incompetent, who had mismanaged every aspect of the crisis, from protective equipment purchases, to test and trace systems, to the protection of old people.

Mkhize is locked in a passing scandal concerning an irregular communications contract granted by his department. This storm in a teacup may quickly pass, but no health minister can rest easy in a world dominated by Covid-19.

In an eerie parallel to the UK this country has also suffered about 150,000 deaths from the virus, and each departed soul has left behind grieving friends and relatives. Unlike his British counterpart, Mkhize cannot hide behind a successful vaccination programme should public sentiment suddenly turn against him.

Cummings testified that he had repeatedly urged the prime minister to sack Hancock, but that Johnson decided to keep him in place. Why? Johnson, it seems, wanted his hapless minister to serve as a sacrificial lamb once that great British invention, the commission of inquiry, began to perform its blame-shifting and mystificatory magic.

• Butler teaches public policy at the University of Cape Town.

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