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HPCSA’s new president ponders the poisoned chalice

On the kindest reading, the guardedness of Prof Mbulaheni Simon Nemutandani, the new President of the Health Professions Council of SA (HPCSA) is understandable – he inherited a controversial, debilitated and dysfunctional outfit, writes Chris Bateman in an exclusive interview for MedicalBrief with the former dentist and public health expert.

Bateman, health journalist and former news editor of the SA Medical Journal, writes:

The HPCSA was established in 1974 via legislation to provide for control over the education, training and registration of health professionals under the Health Professions Act. When challenged with the view that the council’s track record is miserable and its image battered, (the evidence over the past decade is damning), Nemutandani is silent, but he forcefully rejects any contention that it’s dysfunctional. He provides all his comments in writing after declining an online, face-to-face MedicalBrief interview, asking instead for questions to be e-mailed.

He also refuses to provide his curriculum vitae, citing the Protection of Personal Information Act, (POPIA). Not an auspicious start nor engendering confidence in a leader whose immediate predecessors and senior staff did everything they could to thwart official investigations and any form of public scrutiny.


Contrasting styles

One would be tempted to conclude that, in personality and style, he’s the antithesis of at least one former incumbent, Dr Kgosi Letlape; outspoken, controversial and media-friendly, an activist-founder of the Africa Medical Association and past president of the World Medical Association. Letlape had his detractors, but what you saw was what you got. Journalists knew he’d most likely provide them with a catchy headline and he nearly always answered his phone. Letlape’s views, in turn, gained currency.  The relationship, often rocky, sometimes amusing, at least served the public interest and thus the health professions.

To be fair, Nemutandani, inherited an unwieldy, poisoned chalice, given the council’s dysfunction and scandals, with 12 healthcare professional boards, at least one of them, the Medical and Dental Professions Board, (MDPB), deeply uncomfortable at belonging. The SA Medical Association, the voluntary association that represents doctors and of which Letlape was at one stage chairperson, openly backs an MDPB breakaway.

For decades, medical and dental practitioners have wanted to break free to regain clout in representing doctors and to avoid debilitating bureaucratic and political dilution.  Nemutandani’s response on a breakaway by the Medical and Dental Professions Board, (MDPB), is terse and of little help; “council is seized with this matter and will pronounce its decision once finalised”.


Registrar in hot water

But back to the chalice; Nemutandani’s registrar/ CEO, Dr David Motau, a former Free State Health chief was appointed this June, six months after Nemutandani’s election by the HPCSA’s government-appointed council. Motau was arrested on 45 charges of fraud last month.

None of them involving the HPCSA, mind you. Instead, they’re for allegedly flouting the Public Finance Management Act and alleged involvement in corrupt payments of some R8,7 million.

On Monday, 2 August, Motau and 13 others appeared in the Bloemfontein Magistrates’ Court on 304 counts,  ranging from 44 alleged contraventions of the Public Finance Management Act, forgery and one count of “accepting gratification”. Motau claims the charges, which he’ll face again on 22 September, relate to corrupt contracts and tenders that preceded his Free State tenure.  

The Acting Minister of Health, Mmamoloko Kubayi on Thursday, 5 August, put Motau, on “precautionary suspension, effective immediately”, leaving Nemutandani with the added burden of his CEO’s responsibilities. Newly appointed health minister Joe Phaahla lifted the suspension on Tuesday (10 August), just days after taking over the portfolio. Motau has since demanded that the council undertakes to pay his legal costs of an urgent application he filed to have his suspension lifted.


HPCSA ‘dysfunctional and prejudicial’ history

In 2015 and again in 2019, the HPCSA came under withering fire from presidentially appointed enquiries into alleged administrative irregularities, mismanagement and poor governance, with a string of excoriating high court judgements stacked up against it.

In 2015, the late Professor Bongani Mayosi, former Dean of the University of Cape Town’s Medical School, headed a task team which found the HPCSA’s chief executive, chief operating officer and head of legal services unfit for their jobs. Mayosi recommended “appropriate disciplinary and incapacity proceedings” against them, with possible suspension. All three had refused to cooperate with the investigation.

Registrar Buyiswa Mjamba-Matshoba, who also functioned as the chief executive, displayed ‘a lack of leadership and substandard work’ and COO Tshepo Boikanyo was implicated in “acts of unauthorised, irregular and/or fruitless and wasteful expenditure”. Phelelani Khumalo, the former head of legal services, was accused of overseeing a “dysfunctional system of professional enquiries which has prejudiced practitioners and the public”.

The HPCSA’s legal department did not employ a single medical practitioner, or member with a medical background to assist with professional conduct enquiries. Health practitioners and patients waited for years for the Council to process complaints and some foreign doctors waited for up to five years before their registration was completed. After years of investigation, 16 HPCSA employees were put on precautionary suspension, following claims of bribery and corruption involving the registration of healthcare professionals, many of them foreign.

Nemutandani says the Special Investigating Unit, (aka the Hawks), sent him their report on March 10 this year, after which he appointed a legal firm to “conduct internal processes”  that resulted in two staffers being found guilty and being fired in May and June respectively. One disciplinary hearing was still underway, while another 14 employees were acquitted.


Questions and answers

Here’s how Nemutandani responded to other questions (hyperlinks to specific court judgments and internal practices). The turn-around strategy to enhance the HPCSA’s effectiveness and efficiencies through streamlined services is “well advanced”, he says.

“We have moved towards building a new organisation which is reputable for its innovation, professionalism, and excellence in service delivery. Key turnaround times for core and enablement processes were developed with the aim to reduce the overall process time and variability. Council has also completed the design of a new functional and organisational structure to improve efficiencies. The registration process was also reviewed resulting in a significant reduction in turnaround time of this core customer-facing service.”

It was put to him that a reading of several judgments in successful applications brought by foreign and other doctors, plus failed disciplinary actions against healthcare practitioners revealed an overtly legalistic and bureaucratic approach.

Nemutandani replied; “Again, this is yet another incorrect assumption that there is a string of foreign doctors who won High Court judgments (where discrimination and xenophobia were cited), against the HPCSA for blocking their registration while ignoring a lot of foreign doctors who are registered and practising in the country.

“Your statement is incorrect as it is clearly not considering the majority of healthcare practitioners who complied successfully with the same regulations as compared to few judgments that may have been decided on point of technicality. The HPCSA will continue to value the critically needed skills and happily such skilled practitioners within the parameters of the set regulations and guiding provisions in order to protect the public as well as the health practitioners.”

He added; “It will be incorrect to judge the new leadership with the former. However, this Council found significant progress made by the predecessors with predicated converse to your assumptions. Some of the incontrovertible achievements amongst others include the following:

  • Development of the Turnaround strategy, which is being implemented,
  • Benchmarked local and international Health Professions Regulators and recommended best practice,
  • Developed and approved an Information and Communications Technology framework which defines a set of high-level governance processes and structures.

“Leadership vogue will always differ from leader to leader. I am leading a group of determined and committed professionals who would like to be given space to demonstrate their possible capabilities without being pre-judged.”


Life Esidimeni  professional conduct enquiries

Asked about the slow progress in hearings against healthcare officials involved in the Life Esidimeni tragedy that five years ago cost the lives of at least 144 mental health patients when they were transferred to 28 ill-equipped and underfunded NGO’s, to cut expenses, Nemutandani said the matter was now set down for hearing on 14 October.


HPCSA registration fees

Requested to give reasons for the HPCSA hike of registration fees by 40% over the past two years, he replied that the HPCSA was “a statutory body that generates revenues from membership fees received from registered practitioners and those applying for registration. These fees are actually planted back to service the very same practitioners’ needs. In considering the fee increase, the practitioners needs are also factored in. If you divide your referred 40% by the years mentioned, I would not believe that it is a ‘hike’.”

Nemutandani added that the increase needed to be considered in the light of COVID-19 “presenting a universal challenge that led to the worldwide economic shock and affected every industry and every business. The HPCSA is no exception. Endeavouring to assist the new registrants under the circumstances, the Council has already identified that deficiency as one of its strategic projects and where possible the redesign of the funding model will be embarked upon.”


The conduct of professionals

It was put to him that a reading of HPCSA professional conduct verdicts, (including the MDPB’s), showed wildly variable penalties and the question was posed, “are you satisfied that the process is reliable?”

He responded, “Professional Conduct Committees (“Committees”) of Professional Boards are expected by law to be impartial, fair and decide on each matter according to its merits considering the evidence led in each case and weight that has been put on such evidence. After considering the merits and demerits of each case, the Professional Conduct Committee gives a sanction which is fair and just in line with the evidence provided by both parties.”


HPCSA regulatory framework

MedicalBrief asked whether a review of the HPCSA regulatory framework was not overdue.

He replied, “It is incontrovertible that HPCSA’s regulatory and/or legislative provision like any other provision would dictate the review especially more after the current inauspicious ambient brought about the voracious COVID-19. In order to address that, the Council has undertaken a legislative review project with the intention to ameliorate and extenuate where possible and same will be finalised soon.”

It seems a new chapter stands to be written, or to paraphrase Nemutandani, completed.

So far, however, the fast-churning HPCSA leadership has largely proved to be a matter of putting new wine into old wineskins.

  • Professor Nemutandani is the former Head and CEO of the School of Oral Health Sciences at the University of Witwatersrand. He is also the Chairperson of the Association of Deans of Dental Schools in Southern Africa. He qualified as a dentist from the University of Western Cape approximately 30 years ago. He holds three master’s degrees in public health from the University of Venda, maters of science in medicine and specialist in community dentistry from the University of Witwatersrand and a PhD in Public Health from the University of Pretoria. His research interests are on health systems, policy and traditional medicine and HIV.


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