Beth Engelbrecht was head of Western Cape Health Department (WCHD) from 2014 to 2020. Her predecessor Craig Househam ran the department from the late 90s. She was succeeded by Keith Cloete from 1 April 2020.
Engelbrecht's departure was a quiet affair. There was a press briefing January 2020 where Cloete was introduced as her successor (at the Western Cape Government's request, she remained to assist him with the COVID pandemic) but no articles in mainstream media about her tenure. The briefing concentrated on Cloete's and department's priorities.
The absence of press coverage was odd because she held a very important post. Compare that to the fulsome articles when Groote Schuur Hospital CEO Bhavna Patel retired in 2024 and about Eastern Cape health head Rolene Wagner's suspension and reinstatement.
WCHD's Jonga Magazine (issue 24, 17 March 2020) ran a farewell message from Engelbrecht in which she wished Cloete well and thanked the department, MEC Nomafrench Mbombo and her family "for allowing me to follow my dreams".
A two-page article (pp9-10) titled "Simply Beth" carried her brief resume and WCHD's strategy under her leadership. But nothing about why she was leaving except "I will join my husband Willie, we will be living in Franskraal and I will find new ways to serve the community".
Engelbrecht (like Househam) came from the Free State.
It seemed she had no immediate job to go to and her plans were unclear, or kept private. She's presently a researcher and adjunct professor at North West University's health sciences faculty.
A Helen Zille (premier 2009 to 2019) appointee, Engelbrecht stayed only six years. Heads of health, like other department heads, are career administrative posts. Househam remained fifteen years until his retirement. After the premier, it's the second or third most important post in provincial government, higher even than the health MEC who defers to the head in health matters, medical and policy.
So it was unusual Engelbrecht left so soon, especially after rising through the ranks (she was a deputy director before head). Although senior administrators are not elected, they're essentially politicians. It's exceptional for them to leave when they don't have to, the power and influence, especially in a key post like health, being compelling. And it's a very well paid job like all government jobs, management particularly (in 2019 WCHD average employee income was about R750,000).
Leaving a job without a career plan - most people would say why they're leaving unless the reasons were embarrassing or contentious - other than nebulous serving the community seems too sudden for it to have been planned. But perhaps Engelbrecht left for personal reasons she chose not to reveal publically, as is her right.
But let's go back to November 2019 for alternative explanations. That month Daily Maverick published an interview of Engelbrecht with the title "Managing a burning platform". The occassion was WCHD's first ever clean audit. The writer was Maverick Citizen editor Mark Heywood.
A clean audit (incidentally, misunderstood by public, media and politicians) is a South African government audit definition of: financially unqualified and full compliance with legislation and client's own performance objectives.
Engelbrecht spoke of the difficult job "managing a burning platform", that is WCHD. She was upbeat, though, about the good job they were doing.
Though that description applies to the even worse ANC-run provincial departments and national health, all badly run, WCHD is the best of the lot but not as well as it, DA and mainly DA-supporting public think. It has the same problems as any government department in SA except to a lesser degree: inefficient, overstaffed with duplication of duties, ineffective or absent line management, overstressed and aging infrastructure, low capital investment, unaccountable executive, numerous patient complaints and lack of patient-centred approach.
These were well-publicised long-standing problems. In 2018 the Treatment Action Campaign (Heywood's former organisation) reported the WCHD was "failing the people it serves". But due to poor journalism or lacking expertise to do it, Heywood wrote he had no information to contradict Engelbrecht's self-congratulatory story.
So since he didn't do it, I downloaded WCHD's annual report for that year, 2018/19. A snapshot of key financial results for the current and previous four years were available on their website too.
A cursory review of the annual report showed WCHD didn't deserve its clean audit - its performance objectives were not complete; it claimed some metrics were unknown.
Contradicting its own definition of a clean audit, ie performance objectives must be met, the auditor-general accepted it as given: some incomplete. Later that month, November, in emails with me about the matter, then AG Kimi Makwetu spontaneously and unilaterally, and unethically, changed the definition to exclude performance objectives. In effect, to maintain WCHD's audit result, he negated clean audit findings of, or lowered the bar for, any government entity, diluting its credibility. (A sidebar to this is he delayed officially releasing WCHD's audit results, which they attributed to the COVID pandemic declared in South Africa March 2020. But results are typically released December to January so that explanation did not hold. There were undisclosed reasons for the delay. Disclosure: I was a contract AG auditor 2005-2007.)
A DA Western Cape Government complaint going back to 2009 when they took power is Government is not giving the WC its equitable share of money. They say it's difficult to cope with what they have, given increasing migration from Eastern Cape. Then premier Zille and other DA members said it then and since, now Alan Winde.
Engelbrecht, with Mbombo, repeated it 2019 and other times. In May 2019, in response to my complaints of poor service at Groote Schuur and later a clinic, not addressing the issue, she pivoted to alleged pressure on resources and declining budgets over previous years. And in her report of the 2018/19 financial results to the WC Legislature, Engelbrecht said WCHD's budget had been declining every year over the prior four years.
The department's financial reports - snapshot and annual report - contradicted that, though. Since 2013 its budget had been increasing 8% year-on-year, about twice inflation. In 2019 at about R43 billion, it had the largest share of WC's total budget, followed by education (R38 billion; other departments negligible by comparison).
The other "fact" Engelbrecht and Mbombo had presented to the public and legislature was also untrue, that is, increasing numbers of patients from other provinces, mainly EC, were placing WCHD's resources under breaking strain. The fact was the increase in total patient numbers, 3%, matched increases in staff, doctors included.
Incidentally, in WCHD's 2018/2019 annual report Engelbrecht attributed high malpractice claims against the department to legal "touting", an excuse government also uses to explain away medical negligence. WCHD also said it had satisfactorily resolved over 90% of patient complaints. How this almost 100% rate contradicted high malpractice claims was not explained, nor apparently did the AG find it curious enough to question.
Why would Engelbrecht and her DA colleagues make statements over months, years even, that objectively were false (like the DA's claim it had "created" hundreds of thousands of "new jobs" since 2009)? Did they believe it or were they very badly informed despite what their department's financial reports said? Could Engelbrecht as WCHD's chief officer - Mbombo to lesser extent because her post is cosmetic only - not read a straightforward financial report? Or for that matter, even a simple household budget?
Whatever the reason - and it's still difficult to get my head around it - she lied (allegedly) to the public and legislature, the latter an offence. At the least she unintentionally (but how?) misrepresented the facts. Both are inexcusable, worse for a person in her position.
I emailed my findings to Engelbrecht, and separately, to Winde and DA head of health committee in the legislature. I made particular note of her false statement. While researching WCHD's finances, I found a media article and a statement by AfriForum that it had laid criminal charges against Engelbrecht for wasteful and irregular spending of over R20 million for the 2018/19 financial year. I noted this too.
There was no response from any of the three.
The DA claim, and that is also the public perception, they're good to excellent administrators. They're good but often not so much, suffering from overconfidence in their abilities. Perhaps Engelbrecht's management was generally good, but these two instances - unable to understand a simple financial document and false statements to public and legislature - were serious marks against her.
I emailed my findings to Cape Town NPA as evidence of her questionable credibility regarding the outstanding inquest into my late mother's unnatural causes death at Groote Schuur. I noted too AfriForum's charges against her. The NPA replied they were aware of the latter.
Two months later WCHD announced Engelbrecht was leaving.
Jonga Magazine said Engelbrecht was a "good listener". I dealt with her from 2017 about my mother's case and initially thought she might be genuine but quickly found that, like politicians and her colleagues, she told people what they wanted to hear. She was opaque, disingenuous and wouldn't accept responsibility for wrongdoing, all government traits. She was not combative and condescending, though, like, for example, department managers Bhavna Patel and David Bass (she copied him on emails to me but had the grace to omit him when I questioned his veracity). In government language, this is sufficient to be called a good listener.
Jonga described her as "imposing", referring to her height - she's tall - but also personality. I found her indecisive, and when she made a decision (to refer my mother's case for independent investigation after refusing to do so herself, contrary policy and law), she reneged, offering a transparently fraudulent reason: that the panel had disbanded for "logistical reasons". Inquiry committees don't disband themselves. I believe she'd dissolved it to prevent it investigating, her own conduct included, placing self-interest above the public's. Therefore, WCHD's vaunted Independent Complaints Committee was, and still is, rendered useless to political interference.
In all this the DA are no different to the ANC.
In the end my assessment of Engelbrecht was she was in over her head. Her description of burning platforms was accurate if her performance was included - she was part of that "platform": a problematic department and government.
I suspect with two gaffes about finances and resulting criminal charges, not counting an outstanding inquest into a patient's death that she, Patel, Trauma head Prof Andrew Nicol and Zille covered up (in 2017 Zille expressed confidence in Engelbrecht without looking into her alleged conduct), it became too much for the WC Government to keep her on. Another possibility is she was professionally embarassed and the pressure of that and the job became too much and she decided herself to resign.
Most of the public don't know the NPA are obliged to refer credible complaints of criminal wrongdoing to the police even if the complainant doesn't do so himself. Contacting them about Engelbrecht lying to the legislature - proof provided, the link to her report to the Legislature - ought to have been investigated. I don't know if that happened because the NPA and police are notoriously dysfunctional and corrupt when it concerns government malfeasance.
It's hard to imagine Engelbrecht deliberately intended to deceive, though. Instead, she might have repeated what she'd been told without reading the financial summaries herself, nevermind complete report, her department published. But this does not exculpate her especially when she (and Mbombo) had been complaining about alleged declining budgets and increasing patients for a while. Probably Winde couldn't risk the reputational damage to the WC Government and asked her to go.
The event proves what I've been saying, that management throughout Western Cape Health is weak and unaccountable. Engelbrecht was part of a system. If she got it wrong for so long, what does it say about her subordinates and superiors including Mbombo and Winde (incidentally, he's not a graduate) who allowed it by not correcting or advising her? Perhaps they did and she really was not a good listener as Jonga said. Perhaps they didn't understand themselves.
Did Engelbrecht jump or was she pushed from the burning platform? Whatever happened, she was weak and irresponsible, unsuited to be head. She took a drop in status and salary to work as a researcher. It might be a better fit for her, though.
It took outsiders - independently, AfriForum and I - to identify problems in the department. Over time I'd noticed the absence of decent line management in health facilities so this was not an isolated incident; it's systematic. It's hard to know if there have been improvements under the new head Keith Cloete. But what's essential for change is more deadwood must leave or retire.
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