By Jessie Taylor

Fighting the pandemic has required enormous resources and dedication from healthcare officials. Heading up the government’s response has been no small task, especially when taking on a role that has been marred with corruption allegations and tender scandal. Yet, Health Minister Dr. Joe Phaahla has taken up the reins with confidence, driving the country’s vaccination campaign, coordinating the government’s response to the third wave of infections, and preparing for future Covid-19 waves.

 A wealth of experience

In August, Dr. Phaahla was appointed as Minister of Health during a Cabinet reshuffle by President Cyril Ramaphosa. He had served as Deputy Minister of Health for more than two years before his promotion, having helped steer the Department of Health through the Coronavirus pandemic.

Dr. Phaahla’s background in medicine has stood him in good stead. He completed a Bachelor of Medicine and a Bachelor of Surgery (MBCHB) from the University of KwaZulu-Natal (previously University of Natal) in 1983 and has practised at a number of hospitals in KwaZulu-Natal, Gauteng, Mpumalanga and Limpopo. But while upholding his medical oath, Dr. Phaahla was also involved in the liberation struggle and held several leadership positions in movements such as the United Democratic Front before the unbanning of the ANC in 1990.

After democracy, Dr. Phaahla took up positions in government. He was appointed as a Member of the Provincial Executive Committee of ANC in Limpopo in 1991, holding the position for a decade. He was appointed as the MEC for Health and Social Development in Limpopo in 1994, and in 1997 was appointed as MEC Education, Sports and Culture in the province.

At a national level, Dr. Phaahla has served as director-general in the Department of Sport and Recreation and was instrumental in organising the 2010 FIFA World Cup before his redeployment to the post of Deputy Minister of Rural Development and Land in May 2009. He has also served as Deputy Minister of Arts and Culture, giving him broad experience in the management of various government departments.

Dr. Phaahla has always taken a keen interest in the sporting community, and severed as chief executive officer of the SA Sports Commission, the SA Sports Confederation and Olympic Committee (SASCOC)’s predecessor, as well as the Director-General of the 2010 FIFA World Cup Government Coordinating Unit.

The new face of health

Dr. Phaahla took leadership of a department that was at the centre of a corruption scandal (that had influenced the resignation of his predecessor Dr. Zweli Mkhize), and headed into the third wave of Covid-19 infections. Despite the pressures of mounting a health system defence against a new Covid-19 variant and managing what would prove to be South Africa’s most deadly period of infection to date, Dr. Phaahla has been instrumental in driving South Africa’s vaccination programme. His appointment as Health Minister was widely welcomed, with the South African Medical Association (SAMA) noting his extensive experience in the public health system.

“Dr. Phaahla is a medical doctor who has worked in public health institutions in several provinces. This experience, we believe, enables him to better understand the challenges the health sector, as well as healthcare workers, face,” said SAMA chairperson Dr. Angelique Coetzee. The South African Medical Association Trade Union (SAMATU) said the appointment would bring much-needed stability to the department. “The National Department of health is at the centre of the health system and therefore cannot afford to be incapacitated. SAMATU aims to solidify its relations and pledges full support to the Minister’s office,” the organisation said as a statement.

However, Coetzee pointed out that Dr. Phaahla faces an enormous challenge in his new role, with a struggling healthcare sector made up of physically and emotionally drained healthcare workers, on account of the ongoing pandemic.

Rolling out vaccinations

The rollout of South Africa’s Covid-19 vaccinations has primarily taken place under Dr. Phaahla, with the department embarking on the drive to vaccinate the largest demographics of adults under his watch. To date, around 25 million South Africans have received at least one dose of the Covid-19 vaccine – more than 40% of the adult population.

Based on the current trajectory, four provinces have vaccinated around half of their populations, and the rest of the country should follow soon, Dr Phaahla says. Despite extensive campaigning by the health department, officials have faced challenges of vaccine hesitancy and difficulty in reaching those living in far-out rural areas. The government’s communication about vaccines was dealt a blow by the Digital Vibes scandal, in which a R150 million tender was unlawfully awarded. This eroded faith in the department and hampered communication around the pandemic – challenges Dr. Phaahla has been forced to tackle immediately after taking up his role as health minister.

One of the steps in tackling the issue of communication around vaccination has been a public apology by Dr. Phaahla for what he termed a “very unfortunate and devastating saga”. The other has been to harness available resources to communicate the importance of the Covid-19 jabs. During past epidemics, such as HIV, health officials often communicated to those living in remote areas through large community meetings. However, this has not been possible due to the nature of Covid-19 transmissions. Instead, the government has had to rely on social and broadcast media and healthcare worker outreach through community clinics to reach the majority of South Africans.

Dr. Phaahla says the low vaccination uptake and hesitancy among the younger population is problematic and has been driven by misinformation. “It is clear in this population, fake news on social media is making a huge impact and keeping away many young adults from vaccination. We hope as we approach the festive season because they will be more at risk through social and entertainment activities, many more will come forward.” 

Targeted interventions to bolster vaccine numbers

The Health department has also introduced a number of incentives to encourage citizens to vaccinate. These include encouraging event organisers to institute mandatory vaccines policies for attendees, which was successfully implemented recently at an international soccer game. To encourage vaccination, the government is also offering grocery vouchers to those older than 60 – the age group most at risk of severe illness and death.

Targeted interventions have also helped drive vaccine numbers. The department has run two “Vooma” vaccination weekends, in which various government ministers have visited vaccination sites to encourage the public to receive their doses. The three-day drives, which ran in October and again in November, resulted in more than 700 000 vaccine doses being administered. Added to these, the government also ran vaccination drives at targeted voting stations on Election Day.

These efforts are starting to take effect. In the Vaccine Social Listening Report by the Department of Health, there has been a slight increase in vaccine acceptance. “There is multiple anecdotal evidence that there is a small shift in public sentiments from vaccine hesitancy towards more keenness for vaccination in many parts of the country,” the report said.

Increasing the number of vaccinated citizens is one of Dr. Phaahla’s top priorities, especially as the fourth wave of the pandemic looms. Experts estimate that the fourth wave starts between the middle of December and early January, driven primarily by people’s movements over the festive season. The most significant single influence on the severity of the fourth wave will be how many people have received their Covid-19 vaccination, says Dr. Phaahla.

Prioritising mental health

However, Dr. Phaahla’s focus has not only rested on the Covid-19 pandemic. The Health Minister has been vocal about improving mental health services within the public sector. Research has shown that less than one in 10 people living with mental health conditions receive the care they need. This is as a result of access, policy and limited resources, the research has suggested.

However, says Dr. Phaahla, community-based care can be vital in improving mental health services. He adds that stabilising Covid-19 numbers through vaccination will allow the department to focus on the recovery and rebuilding of health facilities and establishing more robust mental health services.

The Health Minister adds that healthcare service often focuses on physical illnesses at the expense of mental health. However, with the pandemic exacerbating the mental health burden, shifting focus has become more important than ever. Research has shown that as much as a third of South Africans reported depression during the first lockdown period. Health officials have also noticed an increase in mood and anxiety disorders, as well as substance abuse.

South Africa’s health department has led the fight against Covid-19 and placed the work of Dr. Phaahla and his department under the spotlight. With the high stakes involved, the Hon. Health Minister has led from the front.

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