“There is no freedom that people can enjoy without proper quality health services.”
Dr. Mvuyo Tom, Co-Director of the Albertina Sisulu Executive Leadership Programme in Health and Vice Chancellor of the University of Fort Hare, says that strengthening South Africa’s health services requires nothing less than three bold steps: Identify what competencies are needed at the district health level. Look at what the competencies currently are. And then fill the gap.
Dr. Tom brings a rich background to his roles in South African academia and health care. With roots on the Eastern Cape, his undergraduate years were at the University of KwaZulu-Natal and his post-graduate studies at University of the Witwatersrand, a.k.a. Wits University.
Dr. Tom went abroad for part of his studies, earning a Master of Science in Public Policy and Management at the University of London’s School of Oriental and African Studies in England.
He’s been focused on health and human rights for over twenty years. In 1994, he was honored with the Nelson Mandela Award for Health and Human Rights “in recognition of extraordinary personal dedication to improving the health of the disadvantaged in South Africa.”
As Vice Chancellor of the University of Fort Hare and Co-Director of the Albertina Sisulu Executive Leadership Programme in Health, Dr. Tom is deep in the heart of how South Africa’s commitment to social justice plays out in people’s daily lives. ASELPH offers an integrated approach to professional development for South Africa’s health leaders. Its focus is on nurturing the skills, competencies, and experiences that will drive a true health system transformation in South Africa.
Dr. Tom spoke to South Africa Partners about why he’s so passionate about health programs and what a nationwide transformation will require.
Can you tell us what inspired you to pursue a career in healthcare?
This was one of the touchstone moments in my life. I was in a boarding school in a rural area. It was September 1971, and I was 19 years old. A friend fell from the roof of a building and he hit down with his head. He was unconscious for some time. No health facilities available. By the time help arrived, my friend was dead.
That experience indicated to me that the need for healthcare providers, especially in rural areas, was paramount. When I started my own health career, my aim was to train myself to be of service in rural areas.
The University of Fort Hare is one of the three partners, along with the University of Pretoria and the Harvard School of Public Health in the United States, that are providing executive-level training to doctors and healthcare managers in South Africa. As Co-Director of this program, the Albertina Sisulu Executive Leadership Programme in Health, you must have a vision of its role in South Africa.
Yes. Leadership development is not really being done thoroughly in South Africa. There is no school of public health here that focuses on executive leadership. That’s why Harvard was brought into the picture, because it has an excellent program on executive leadership. At this point, ASELPH has defined the niche of executive leadership as its own.
Right from ASELPH’s conception, discussions were held with the South African Department of Health and the Minister about what kinds of training would be most useful. We have the direct involvement of the leadership of the National Department of Health — South Africa’s Deputy Director General responsible for human resources is now chairing the ASELPH Steering Committee.
Provincial governments and the provincial Department of Health are participating in ASELPH , too. They’re assisting to ensure that the program succeeds, and they’re also bringing in their leaders to be trained.
Can you say more about how ASELPH is helping with South Africa’s larger health transformation agenda, including the push toward decentralization?
Transforming our country’s healthcare is one of the top agenda items of the Minister of Health. That makes a program like this, which trains health managers and leaders, quite essential.
South Africa is moving toward decentralization of healthcare services — this was a priority way back in 1994, when the health services of the new South Africa were first being planned. Decentralization has been identified as one of the key performance areas for any health system.
Helping district health teams and managers become better leaders is definitely a big part of ASELPH’s mission. There is a huge challenge right now with the current lack of competencies within the district managers in the country. We have to identify what competencies are ideal for a district health system, and look at what the competencies are that are found in South Africa currently. Then, we have to fill that gap.
What are the district health system responsibilities going to be in the context of the South African Constitution and the Health Act? What is the model that South Africa wants to have for a district health system? We don’t know the answers to these questions yet, but the Harvard School of Public Health has got plenty of experience when it comes to the district models around the globe. They’re helping us look at what the ideal model can be for South Africa.
All of this is about transforming the health system in the country to be able to do what is necessary for an equitable, quality health service.
You participated in senior executive programs yourself. How do you think those personal experiences are shaping your role with ASELPH?
I’ve applied my experience with the University of London’s School of Oriental and African Studies’ EVA program — which stands for Ethics Values and Attitudes. This model focuses on how executives should lead by example to ensure that organizational culture is very ethical and value-based.
Before I became the Vice Chancellor of the university, I was able to use my experience with the case study teaching method and transmit to the students the message that the development of executive competencies should not only be about skills and knowledge but about attitudes as well.
We want to develop more case studies that are local to South Africa. Students are asking for them.
It makes a lot of sense to have case studies that are local.
Exactly. Local cases are very helpful because they go into the experience that you see on the ground and that you’re familiar with.
For instance, South Africa passed restrictive tobacco legislation in 1993, during the time of the early transformation of health services. This would be a great case study. The legislation was a turning point for the health system in addressing a wide-spread, general phenomenon that affected a huge portion of the population, seeking to change public attitudes with the implementation of policies like no smoking in public places. This legislation also involved confrontation with the private sector, such as the tobacco companies. Transformational change of this magnitude and winning over often difficult people required a strong leader in the Department of Health who could drive it through — particularly as it was accompanied by other transformative policies at the same time, like the Choice on Termination of Pregnancy Act.
What are some of the biggest challenges that you see right now?
Just ensuring that there are actual professionals to provide the basic level of care. Medical doctors, especially in the district areas, are located mostly within the private sector. Therefore, there are few primary healthcare doctors available except in hospitals. That is not going to sustain the proper healthcare at the district level.
Contracts are being planned for medical practitioners to be recruited into the public health space. And the National Health Insurance will have to improve facilities.
Big picture, what are your primary goals for ASELPH during your tenure of leadership?
The first goal is to expand the program beyond the partnership that we have with the three universities. At the University of Fort Hare specifically, we want to use ASELPH as an opportunity to master the process of training executive leaders of the future. UFH must be able to have the capacity to develop new programs that build upon ASELPH and make executive leadership training sustainable within our university. That includes both a Master’s Program as well as short courses for executives who don’t want a degree but just want to focus on a particular area.
The second key area of performance would be to have executive leaders maintained in the provinces and in the districts — effective leaders in terms of their skills, knowledge, and attitudes. By the time they finish this program, we must have a nucleus of leadership.
And thirdly, I think we have to have a buy-in from government that people who are trained and developed through this program must be retained as much as possible. The system must not hemorrhage and bleed to such an extent that some of these people are not able to maintain their jobs.
This last point is crucial. We want to make sure that these younger people do not end up discouraged because their skills are not recognized or are not utilized. That would be a disaster. Because if that happens, they will pull out from the public sector and go use those skills in the private sector.
At the beginning of the interview, you said it was a personal experience when you were 19 that drew you into healthcare. Other moments must have reinforced that commitment over the years.
My participation in the struggle for liberation exposed me to various experiences that shaped me, even after I had qualified as a medical doctor.
One experience was the massacre of ANC activists in Maseru. Among those killed was a comrade and colleague of mine who had just qualified as a medical doctor. He was doing an internship in the same hospital where I was working. He had gone to Maseru in Lesotho as part of his vacation and made contact with ANC members in Lesotho.
The other experience was my own detention without trial for about six months. I was in solitary confinement. Whilst detained I was assaulted by the security police and taken to a state district surgeon. He showed so much callousness and insensitivity in his so-called “caring” for me. He actually commented that the police had not caused any extensive injuries in me and that he had seen worse injuries than mine. When I challenged him to take my blood pressure and test my urine he was furious that I thought I knew better.
Whenever I see the crumbling of our health services for our people, I am so clearly reminded of what is at stake. There is no freedom that people can enjoy without proper quality health services. We as the leaders in health must ensure that people are well served.