The Diagnosis of Patient South Africa

By Mohamed Motala · 21 Jun 2011

A+ A= A-
    Print this page       comments
Picture: chickenlump
Picture: chickenlump

The National Planning Commission’s “Diagnostic Overview” report is a welcome policy discussion-document that has been needed for a long time in South Africa. It deserves praise for putting forward some important policy considerations that warrant closer examination. The diagnostic report is an important milestone in that it opens up the “big questions” about our post-apartheid democracy in a coherent and complete manner.

For too long now there has been resistance and complacency within government to open up a discussion about our overarching macro public policy architecture. Since the adoption of our constitution - for too long - our democracy has not been questioned about its inability to deliver justice to the majority. The public has had to contend with incoherent and conflicting public utterances by highly placed politicians, having to make sense of whether these are genuine policy debates or just political jostling. The nationalisation debate is a case in point.

The planning commission was mandated to set up key targets for South Africa by 2030. One of its first reports is this “Diagnostic Overview” that determines the “diseases” of South Africa, based on the “symptoms” that patient South Africa presents. This is what the standard definition of a diagnosis is.

But upon reading the report, one gets the feeling that it is hampered by the tools used for diagnosis, as they tend to remain somewhat superficial.

Just like when a sick patient is examined without the proper tools, simple visual scanning misses what lies deeper within and that can only be seen by an x-ray machine, for example. This results in the diagnosis not really getting to the root of the cancer hiding in the bones of the patient.

Similarly, the diagnostic report is commended for using history and context to understand South Africa’s problems, just as the family history of the patient is the first diagnostic assessment tool used, but structure is not so well illuminated in this report’s set of tools. Thus, the “symptoms “ require some grounding in what has given rise to them.

To understand exactly what the disease presents requires delving a little deeper into the underlying structural problems in society and the economy. In the diagnostic report, colonial apartheid history is well documented as the villain of poverty, unemployment, inequality and racism. But, the economic system that drove and deepened all of this, is shied away from in exposing the real malaise affecting patient South Africa. 

The report sets out the context as the energy transition, food security, climate change and new technologies; all of which is true and relevant, but the structural forces that shape these contexts are less expanded upon. The disease lies deeper and structural theory provides a useful diagnostic tool as it completes the picture by explaining what shapes society as a whole as well as the classes within.

Structural theory does not rely on explaining the behaviour of individuals only, but sees the whole picture in all its complexity including the relationships between different parts. Using this diagnostic tool, it becomes clear that wealth and poverty go together and trying to understand poverty in the absence of understanding wealth is not helpful.

Nine symptoms are used to call attention to widespread poverty and unemployment - which none can dispute - but the report falls short in that it is silent about extreme wealth and the nature of employment where, for example, white men continue to occupy the best paid jobs and “white unemployment,” according to the latest figures from Statistics South Africa, hovers around 6%. Not putting such facts under the microscope, doesn’t allow for a full diagnosis to be made. 

Inequality is diagnosed, but is presented as add on and not central to the diagnosis, as poverty and unemployment are elevated as the prime symptoms. Thus, the report doesn’t follow through with unveiling wealth and its concentration as the monster lurking behind poverty. Everywhere poverty and unemployment are to be found, the opposite, wealth and its concentration are usually close by.

Take spatial inequality and spatial challenges, which the report diagnoses as an example of what is wrong with South Africa. Today Bantustans and urban peripheries continue to exist. They are usually comprised of poorly functioning rural provincial authorities and failing municipalities. These locations are full of unemployed poor black people. Looking at them in isolation will not provide the answer as to why they stubbornly persists because their existence is not a function of what lies within the Bantustans and poor urban peripheries. You have to also consider extreme wealth and concentrations thereof in the more industrialised provinces and northern suburbs of the metros and see this as part of the problem too.  

I am not arguing that there’s something wrong with being employed and enjoying a comfortable life. But understanding poverty and unemployment requires understanding extreme wealth and how it comes about. It is only when wealth is diagnosed as the problem that the solution will start using wealth and the wealthy to heal ailing South Africa.

Thus, applying a diagnostic tool that elevates justice, and understanding inequality as part of the symptoms of injustice, leads to a much better diagnosis.

Similar to its failure to recognise spatial justice and only identify spatial inequality, the report looks at education and healthcare in the context of the failure of the public education and healthcare systems, but does not go further by examining the expansion of private healthcare and education.

Does it mean that if rich people can afford exorbitant school fees and private hospitals (whose services and ethos are also dubious), that this is not part of the diagnosis? When inequality is defined as a problem associated with poverty and not wealth, then the solutions are also about fixing poverty without addressing the problems of wealth.

So bringing all those that rely on private schooling and private healthcare into the diagnosis reveals not only why they opt for those solutions, but also channels their monitoring, evaluation, management and lobbying skills to deliver a better service for all. Not only do they bring important skills, but their self-interest also gets translated into society’s interests when the rich and poor are part of one health and education system.

If you identify the problem correctly then it makes finding a solution easier.

In the diagnosis, a rights-based approach continues to manifest itself in the way in which problems are identified. Assuring the rights of both the rich and the poor only results in the rich having their rights assured in an unequal society such as ours. The poor are too busy struggling to survive and trying to avoid being criminalised. They are trying to live and work in places that are occupied by those more fortunate whilst aspiring to and trying to catch up with the rich who are presented all around as the faces of success.

The NPC sets out a vision for consultation and wishes to consult on the diagnostic report. This is good. However, the parameters for consultation should not be restricted; rather they should be guided by the issues that have been raised. Yes, they do revive all the usual suspects, but if we want to move beyond the usual, then lets dig a bit deeper.

The report identifies corruption and maladministration in the public service as a problem, but if the drivers of our development model are “profit taking” and the systems relied upon are “businesslike,” then fixing unequal growth will not happen by managing things better. You have to unearth the drivers of the problem, which in this case is “how to get rich quick” by growing an unequal economy, whereas a proper diagnosis would consider justice and reducing inequality as the most serious symptom we present.

Motala is executive director of CASE, the Community Agency for Social Enquiry.

Should you wish to republish this SACSIS article, please attribute the author and cite The South African Civil Society Information Service as its source.

All of SACSIS' originally produced articles, videos, podcasts and transcripts are licensed under a Creative Commons license. For more information about our Copyright Policy, please click here.

To receive an email notification when a new SACSIS article is published, please click here.

For regular and timely updates of new SACSIS articles, you can also follow us on Twitter @SACSIS_News and/or become a SACSIS fan on Facebook.

You can find this page online at

A+ A= A-
    Print this page       comments

Leave A Comment

Posts by unregistered readers are moderated. Posts by registered readers are published immediately. Why wait? Register now or log in!


TheDrake Verified user
27 Jun

One cannot multiply wealth by dividing it.

Respond to this comment