Address by the former President of the republic of South Africa, H.E. Kgalema Motlanthe, on the occasion of the second Dr Molefi Sefularo Memorial Lecture held at the Sefako Makgatho Health Sciences University on 29 November 2020

Programme Director;

The Sefularo family, Mme Kgomotso, the kids, relatives, friends and comrades of Dr Sefularo;

The Board of Trustees of the Dr Molefi Sefularo Foundation;

The Vice-Chancellor of the Sefako Makgatho University, Prof Peter Mbati;

Leaders of the ANC and the Alliance; Representatives of civil society organisations;

Esteemed Members of the Academia; Comrades and Fellow compatriots: How does one begin to pay tribute to Dr Molefi Sefularo: a distinguished medic, an intellectual giant, a humble man of the people, a practising ideologue, a revolutionary and African Communist, an unsung hero, a competent servant of the people of South Africa to the end who left us too soon? Where do I begin and end in honouring such an illustrious life well-lived; a life taken away from us at its prime, when as a people and as a movement we were still expecting so much from?

Dear friends, these are some of the questions that came to mind as I humbly ac- cepted the invitation from the Sefularo family together with the Dr Molefi Sefularo Foundation to deliver this Memorial Lecture. As I was pondering these questions, I concluded that it is perhaps fitting that I anchor this Lecture on the words of EL Commandant Fidel Castro in his 1967 eulogy to a fellow revolutionary, Che Guevara, when he said the following:

“It is not easy to find in one person all the virtues found in him. It is not easy for a person to be able to develop a personality like his. I would say that he is a type of a man who is difficult to equal and practically impossible to improve on. But I would also say that men like him are able with their example to help the rise of other men like him.”

In Dr Sefularo we had a comrade with virtues that were difficult to equal and practically impossible to improve on. As we today honour his memory, we do so in the belief that men like him are able with their example to help the rise of other men like him. Accordingly, let us declare boldly that in us Dr Molefi Sefularo has not died.

One outstanding attribute of Dr Sefularo was that he interfaced with the grassroots with ease and believed in engaging communities on the challenges that confronted them. It was this very disposition that would have prompted this to utter the fol- lowing words: “We found that South Africans want to sit and talk and solve problems together. It was just to go back to sense and sensibility and just being more open and trusting other South Africans.”

Dr Sefularo’s deep roots among the people made him an important interlocutor in the debates that helped shape the programmes that the ANC government adopted in the post-1994 era. He carried the belief in the masses into his many roles that he was entrusted with, which include serving two terms as the MEC of Health in the North West, a member of Parliament and a national Deputy Minister of Health.

Through this Annual Lecture and the work of the Foundation named in his honour: the Dr Molefi Sefularo Foundation, we will keep his memory alive. We will immortalise his legacy, which we are proud heirs of. In keeping with what the example of Dr Sefularo has taught us, I hope that this lecture series would contribute to stimulating dialogue on the more pressing challenges that we continue to face as a society.

Perhaps now, more than at any other time, we need to tap into the collective wisdom of our people and “let a hundred flowers bloom, let a hundred schools contend” in line with Chairman Mao’s dictum. Let this become a platform for encouraging mean- ingful dialogue which highlights our challenges, but even more importantly one that breeds new ideas on the way forward. Dr Sefularo would have expected no less of us. I, therefore, wish to congratulate the Dr Molefi Sefularo Foundation and its partner, the Sefako Makgatho University, for this worthwhile initiative.

Among the many challenges that face as country, region and continent, health ranks high up. It is appropriate that the Dr Molefi Sefularo Foundation has elected to focus its 2020/21 lecture series and public engagements on health-related matters. The man whom we are celebrating was many as alluded to above. He was a student leader, a politician, a medical practitioner, but it would not be amiss to venture that his most abiding contribution was a proponent of public health. Dr Sefularo was an important voice in the discourse around health policy in which he also played a role in its formulation and implementation.

The Dr Molefi Sefularo Foundation has decided to focus the 2020/21 lecture series and public engagements to honour his passion around integrating health systems to benefit the broader SADC population. This perspective is borne out of his desire to see NHI succeed in SA, but also in recognition that health benefits have to accrue to the entire region if benefits are to be sustainable and meaningful. As an avid proponent of PHC and District Health Services. Comrades, I am delivering this Lecture at a time when our country, the African conti- nent and the world are engaged in a titanic battle against an invisible enemy that is de- stroying lives and livelihoods: the COVID-19 pandemic.

One of the things this pandemic has taught us is that as humans we are interconnected; that our destiny is linked; and that without the other we are incomplete. The pandemic has highlighted the importance of collaboration and integration, for acting alone none of us can find adequate responses to the pandemic and its resultant economic devastation.

Accordingly, it is equally fitting that this Lecture is themed; “A case for regional inte- gration in the light of COVID-19”. Comrade Sefularo himself understood and appreciated the power of collaboration and integration. We know this because as a community activist in the township of Itsoseng and a medic at Thusong Community Hospital, he championed the integration of western medicine with indigenous African healing practices.

As MEC for Health in the North West province, he successfully led the amalgamation of the fragmented departments of health inherited from the then Bop government, the Western Transvaal TPA Health Services, Cape Provincial Administration Health Services and the National Department of Health. Under his stewardship, the North West Department of Health was a leader in the country in the implementation of the District Health System, which emphasised cooperation and integration between the department and municipalities.

While deployed as a Member of Parliament, Dr Sefularo took a keen interest in ensuring that health policies were integrated into the broader socio-economic policy framework of the government. He believed that was key to delivering “Health for All” to give effect to the Freedom Charter’s injunction that: “Free medical care and hospitalisation shall be provided for all, with special care for mothers and young children.” Dr Sefularo held firmly that a healthy populace was central to the attainment of socio-economic development and transformation that we so direly yearn for in South Africa and Africa at large.

Despite arriving late on our continent, COVID-19 has spread rapidly, taking a heavy toll on human life and causing major disruptions to economic activity. With lower public resources and health systems that were already under pressure before the out- break of COVID-19, countries in Sub-Saharan Africa face a particularly daunting task in responding to this pandemic.

The World Bank projects that the pandemic will cost Africa between US$37 billion and US$79 billion in terms of output losses for 2020. It is estimated that African countries will require US$ 100 billion to respond to healthcare and social safety net needs arising from the pandemic. This sobering reality points to the urgent need for an integrated response at a regional and continental level. “Health for All” is a clear and specific target of the SADC Health Programme and it is grounded in all its founding documents, Common Agenda, Strategic Developments Plan as well Health Policy Framework. Each SADC country, however, develops its health legislation on its own, based on its resources as well as long-term strategic framework. South Africa’s current health policy thrust is focused on NHI, within which mention is made of health insurance for migrants.

While common health campaigns have been undertaken within SADC, several questions still arise: If “Health for All’ is to be realised within SADC, policy harmonisation between member states becomes critical especially given the limited resources. How much of this is happening.

Free flow of people within SADC (legal and illegal) is an everyday reality. Does our current planning take this into account? Is our response to this cross-border health-seeking behaviour practical, systematic, efficient and well planned or is it erratic? To what extent does SA’s NHI policy framework provide adequate resource allocation at the point of care? Are there mechanisms, planned or existing, for cross border tracking? What lessons have we learnt from COVID-19?

Many diseases communicable and non-communicable have in the past plagued the continent but were mostly dealt without expecting the involvement of neighbouring countries. There has not been until now, any need for rigorous tracing of people movement to ensure containment of diseases. The advent of COVID-19 as a pandemic and resultant responses has sharply exposed the massive cracks in the ability of SADC as a region to respond successfully to regional health crises. Hitherto, citizens of the region in need of medical attention, especially of a sophisticated nature, have gravitated towards where the resources and expertise are located. In chasing the quality outcomes people rightfully seek, there is a clear and persistent flow across borders. This pattern of movement in search of health services is compounded by and may even be secondary to the search for economic refuge.

South African has attracted a lot of migrants for several reasons. Economic m grants, asylum-seekers from war-ravaged neighbours are attracted to our country for opportunities, including health care. This does not stop those who come in through illegal means who in terms of our constitution and the bill of rights may not be refused care or some of the humanitarian services basic to all humans. This has not been well managed and has the potential of causing an overload on the health system. As migrants cross in and out unnoticed, a whole range of problems can arise for countries involved.

Our healthcare system and those of our SADC neighbours are based on Demographic and Health Surveys, which collect and use data to monitor and evaluate population, health, and nutrition programmes. The surveys have directed funding as per the morbidity and mortality of catchment populations. This notion of the catchment population ignores just about all the dynamics above. There is very little doubt that the free movements of the SADC population demand healthcare systems and complementary funding mechanisms; and recognises reality brought about by disparities in resources, expertise and outcomes. Over and above this, the free trade and tourism we want to encourage within SADC demands of all members to improve their respective health systems, but more crucially requires better coordination.

While Regional Health Integration is the ideal that we aspire to, perhaps more and more efforts need to go into a harmonised regional policy framework, that is an essential steppingstone for interoperable systems required to enable better coordination, patient referral, outbreak response and reporting systems. The above requires a concerted amount of research and development of a conceptual framework that can then inform policy at a country level and within the region. This integrated response must go beyond health care issues. It must touch every aspect of human endeavour. The implementation of the Africa Free Trade Area is an important step in this direction.