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How the health department bends the law to gag health workers – report

  • A report released by the Campaign for Free Expression says there is a growing attempt to silence government health workers to cover up maladministration and corruption.
  • Researchers argue health workers have to watch their patients die of preventable causes, often due to a lack of equipment and understaffed health facilities, because they’re banned from speaking out about their work conditions. 
  • The report recommends that temporary suspension letters of health workers should explain how a disciplinary committee decided on the severity of a worker’s wrongdoing.
  • Bhekisisa’s news editor, Joan van Dyk, live-tweeted the event and our reporter Jesse Copelyn was at the Tshwane launch. Van Dyk’s tweets are embedded below. Look out for Copelyn’s in-depth analysis of the report’s findings in the next few weeks.
  • Read the full report.

Government health workers in South Africa have to watch their patients die of preventable causes — often due to a lack of equipment and understaffed health facilities — because they’re banned from speaking out about their working conditions, a report of the Campaign for Free Expression found.  

The Public Service Rules and Regulations prevent state health workers from speaking to the media — they are only allowed to raise issues internally, regardless of the public interest, or else they face disciplinary action. 

The researchers interviewed public health workers and reviewed legal frameworks, international guidelines on human rights and media reports. 

Researchers argue the “growing” attempt to silence government health workers point “to efforts to cover up maladministration, corruption, and the violation of human rights emanating from the  government’s failure to provide basic healthcare services to the public.” 

Some health workers told them that when they try to raise their concerns, hospital managers harass and intimidate them, and because whistleblowers aren’t protected they simply keep quiet. 

In June, Tim de Maayer, a paediatrician at the Rahima Moosa Mother and Child Hospital in Johannesburg, was suspended because the Daily Maverick published his open letter about the worsening conditions at the hospital, which contributed to the deaths of children. He addressed his letter to the hospital administrators and the health department.  

De Maayer was put on precautionary suspension so that the department could investigate “allegations of unbecoming conduct”. 

Widespread media support for De Maayer and pressure from health activists such as the Progressive Health Forum led to the hospital reinstating De Maayer within a few days without completing their investigation. 

Flawed decisions

The report’s researchers say that the decision of hospital managers to take disciplinary action against “an employee exercising his rightful duty to service the interest of the public” appears flawed. 

If someone is being disciplined, the Public Service Rules and Regulations’ disciplinary code and procedures state the harshness of their punishment is supposed to be measured according to how likely the misconduct (in De Maayer’s case the act of speaking out) is to prevent service to the public. 

De Maayer’s letter of precautionary suspension shows, according to the Campaign for Free expression’s report, that his wrongdoing was classed as “very serious misconduct” even though De Maayer’s letter “served, rather than harmed, the interests of the public”.

In March, less than a year after De Maayer’s letter, the health ombudsman released an investigation into conditions at the Rahima Moosa hospital, which confirmed De Maayer’s allegations. The ombudsman, Malegapuru Makgoba, found the facility was indeed in a dire state. Three words were mentioned in almost every interview with patients or health workers, he said: “dirty”, “filthy” and “unsafe”.

In another case, in June 2020, Ebrahim Variava, an internal medicine specialist from Tshepong Hospital in Klerksdorp, was suspended because he publicly commented that the Northwest government was ill-equipped to deal with COVID-19. Variava only spoke out after his attempts to do so internally (for instance, about drug stock-outs), didn’t get any response. 

The health department then accused Variava of bringing them into disrepute. Following pressure from activists, Variava was reinstated two weeks after his suspension. 

Then, in 2021 Babita Deokaran was assassinated outside her home after calling attention to mismanagement of Tembisa Hospital’s budget. A year-long investigation by News24 found that Deokaran was trying to stop suspicious transactions worth millions in the days before she was killed.


The Campaign’s report recommends that: 

  • Whistleblowers need more protection from the government; 
  • Public facilities should know how to interpret the laws they’re enforcing; 
  • Temporary suspension letters should explain how the disciplinary committee decided on the severity of the wrongdoing; 
  • Such letters should also explain why the misconduct is seen as not being in the public interest;
  • The public, health workers and the media should be able to access the health department’s communication policies easily; 
  • Hospital CEOs must be appointed by an independent board, not by the provincial health MEC. 

Take a look back at some of our previously published stories that illustrate how much of the public’s knowledge of what’s happening at public health facilities comes from government health workers speaking out — at great personal risk.

For reporting that uncovers how the governance of South Africa’s public health system fuels corruption and maladministration, read this article.

The following people were panelists at the launch of the Campaign for Free Expression’s report:

  • Alex van den Heever, chair, social security systems administration and management studies, Wits school of governance
  • Ebrahim Variava, adjunct professor at Wits, internal medicine department; internal medicine department head; head of at Klerksdorp Tshepong Hospital, North-West
  • Hanifa Manda, project manager, Campaign for Free Expression and Young African Leaders