Department of defence still reviewing SA-Cuba agreements:
The department of defence is still reviewing South Africa’s bilateral agreement with Cuba, Project Thusano, and all sub-contracts associated with it, the office of the auditor general told parliament’s standing committee on public accounts (Scopa) on Tuesday.
Inked in 2012, the controversial and costly project was supposed to last for only five years. It has, to date, cost taxpayers more than R2.6 billion.
Project Thusano was initially intended to focus on the maintenance and repair of the South African National Defence Force (SANDF) operational vehicle fleet but has morphed to include expensive supplementary agreements such as training soldiers as medical practitioners and mechanical engineers in Cuba.
Mbali Tsotetsi, representing the auditor general, told Scopa that the AGSA had recommended to the minister of defence that all the agreements be reviewed, and that was being done.
In a written response to a question from the Inkatha Freedom Party in April 2023, then defence minister Thandi Modise said she had “given instructions to review Project Thusano”.
Tsotetsi made the remarks on Tuesday in response to a question from Scopa chairperson Songezo Zibi.
The Rise Mzansi party leader had asked whether the auditor general had seen the bilateral agreement and been able to ascertain if South Africa was “able to reap the benefits of what the Cubans would do for South Africa, or was it just straight procurement, outside of the framework of the Public Finance Management Act”.
Tsotetsi said the AG had seen the agreement, which stated that “both countries will cooperate on the matters of defence, but does not specify in what manner”.
The supplementary agreements were more detailed, she said. “What we noted there, was that it follows procurement processes in a way, because it says the department of defence will acquire services, and part of those services include the repairs of the military vehicles, training [of medical professionals and so forth].”
It was the auditor general’s opinion that the defence department should have followed a procurement process or, in the absence of a “normal procurement process”, should have obtained a deviation that would justify why the services were procured from Cuba.
In the absence of a deviation being sought from the treasury, it was concluded that the expenses that were incurred would be irregular expenditure, she said.
There was a need to review the bilateral agreement and the supplementary agreements so that there was benefit to the defence department, not only Cuba, she said, and that was happening.
Tsotetsi was joined by colleague Eduard Coetzee, who said the auditor general had been unable to confirm that “appropriate procurement contract management processes were followed at the outset of the contract” between the countries.
To date, 108 defence members have been sent to Cuba to study in three medical professions, according to Coetzee.
The auditor general has previously reported that the defence department paid 136% more (R2.7 million versus R1.1 million) for a medicine student studying in Cuba compared with a South African tertiary institution.
Of the first cohort of 21 medical students sent for training in Cuba, only six successfully completed an 18-month integration course at the University of Pretoria upon their return to South Africa, Coetzee said.
Psychology students, meanwhile, failed to pursue further qualifications required to practise professionally, instead being relegated to administrative roles.
In biomedical engineering, graduates found their Cuban qualifications unrecognised by South African accreditation bodies. The Engineering Council of South Africa and the South African Qualifications Authority do not acknowledge the Cuban curriculum, leaving the students unable to register and practice in their fields.
“The impact of this is that additional spending is incurred compared to if those [students] were trained in South Africa,” said Coetzee.
The root cause of the failures stemmed from poor planning and execution by the defence department, which failed to ensure the Cuban curriculum met South African accreditation standards before enrolling students, he said.
The programme also lacked a clear career development strategy for returning students, Coetzee added.
Without a structured plan for integrating trained professionals into the workforce, many graduates had been left underused, their skills wasted.
The absence of alignment with domestic healthcare priorities further exacerbated the issue, leaving critical medical posts unfilled despite the heavy investment in training.
The defence department should align future programmes with South African accreditation requirements and healthcare priorities, according to Coetzee and Tsotetsi’s presentation.
Key recommendations included that there be collaboration with the department of health to guarantee that all training programmes meet domestic statutory and accreditation standards.
Local training institutions should also be prioritised to reduce costs and ensure qualifications are directly applicable to the South African context.
Structured career development pathways should be structured to maximise the use of trained professionals and address critical healthcare shortages.
In October, the auditor general told Scopa that the defence department — which received a qualified audit for 2023-24 — had incurred irregular expenditure of R14.39 billion over the past five years, the most, by far, of any government department over the same period of time.
For the first time, the elimination of a cancer is within our reach:
Every year, more than 350 000 women across the world die from cervical cancer and another 660 000 are diagnosed. As a consequence, children are orphaned, families impoverished and communities diminished by the loss of mothers, wives, daughters and sisters.
And yet, unlike most other cancers, almost all these cases and deaths can be averted. We have powerful vaccines that can prevent infection with the human papillomavirus (HPV) that causes cervical cancer, we have diagnostics to detect it early and we have treatments for those it strikes. With these tools, cervical cancer can not only be stopped, it could become the first cancer to be eliminated.
Some high-income countries are already close to elimination, meaning fewer than four cases per 100 000 women. But in many low- and middle-income countries, these tools are still not available, which is why 94% of cervical cancer deaths occur in them.
The double tragedy of cervical cancer is that this is not just a health issue; it is an equity issue.
Monday 17 November, marked the global Day of Action for Cervical Cancer Elimination, with vaccination drives, screening campaigns and advocacy events. Landmarks were lit up in teal, including Rio de Janeiro’s iconic Christ the Redeemer monument, which welcomed world leaders arriving for the G20 Summit, which started on 18 November.
In 2018, the World Health Organisation (WHO) launched a global call to action to eliminate cervical cancer, which was followed in 2020 by the adoption by all 194 WHO Member States of a Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem. The strategy calls for countries to achieve three targets by 2030: 90% of girls fully immunised against HPV, 70% of women receiving timely screening and 90% of those found with precancer or cancer accessing treatment.
These targets are not just aspirational, they are achievable, even in low- and middle-income countries. Bhutan, for example, has already reached the targets, the first to do so in the South-East Asian region.
Since introducing the HPV vaccine in 2011, Rwanda has reached vaccine coverage of 90% and recently announced its national goal to reach the 90-70-90 targets three years ahead of schedule, by 2027. Already, in two districts — Gicumbi and Karongi — the country is meeting those goals.
Nigeria, which introduced the HPV vaccine in October last year, has already vaccinated 12.3 million girls.
We have the tools and the opportunity to eliminate cervical cancer. Realising that opportunity requires determined political leadership. As world leaders take part in the G20 Leaders’ Summit in Rio, we need their commitment to maximise access to the tools that can deliver it.
First, we call on G20 leaders to support access to HPV vaccines for all girls, in all countries. Since WHO issued the global call to action in 2018, more than 60 countries have introduced the HPV vaccine into their immunisation programmes, bringing the total to 144 countries that are routinely protecting girls from cervical cancer in later life.
With scientific advances, we can now prevent cervical cancer with just a single dose, which 60 countries are now doing.
The largest provider of HPV vaccines to low- and middle-income countries is Gavi, the Vaccine Alliance, which plans to vaccinate 120 million children between now and 2030. But this plan requires that investments in health are sustained. We are also counting on manufacturers to confirm and honour their commitments to provide HPV vaccines to low- and middle-income countries in the coming years, to avoid the supply constraints that held back progress in the past.
But we cannot rely on vaccines alone. The impact of the rapid scale-up in vaccinating girls now will not be seen for decades, when they reach the adult years when cervical cancer typically appears. To save lives now, we must match the increase in vaccination with increases in screening and treatment.
So, second, we call on G20 leaders to support access to screening in all countries.
Decades ago, as more women gained access to pap smears in developed countries, the mortality associated with cervical cancer dropped rapidly. Today, even better tests are available. Over 60 countries now include high-performance HPV tests as part of their screening programmes.
Women can even collect their own samples for HPV testing, removing more barriers to life-saving services. In Australia — which is on track to become one of the first countries in the world to achieve elimination — more than a quarter of all screening tests are now done this way.
We call on leaders to move beyond ad hoc, opportunistic testing by investing in organised screening programmes that will support high coverage for the whole population. That is critical for reaching the 70% target. However, high test prices and vendor mark-ups are also still a barrier.
Several countries are also investigating the use of artificial intelligence to enhance the accuracy of screening in resource-limited settings. When women are found with precancerous lesions, many are now treated with portable battery-powered devices, which can be operated in remote locations.
Third, we call on G20 leaders to support expanded access to treatment in all countries. Advanced cases need to be referred for surgery, radiotherapy and palliative care. But in many cases, women with cervical cancer die simply because the treatments used in high-income countries are not available where they live.
In countries where radiotherapy equipment is broken, women wait in vain as their tumours grow. No woman should have to travel abroad in search of a cure, or die waiting, when the equipment to cure her is installed in her own country.
The Covid-19 pandemic demonstrated the extraordinary power of vaccines, tests and treatments to save lives, but also the inequities in access that result in preventable deaths.
We urge all leaders, all sectors and all communities to join us in ending cervical cancer once and for all.
Dr Tedros Adhanom Ghebreyesus is the director general of the World Health Organisation.
Sanitation timebomb: Flushing is a luxury we can’t afford:
On World Toilet Day — 19 November — we have to learn from the consequences of climate events, both floods and droughts. Many people highlight the water crisis but the issue of sanitation is downplayed.
The failure of infrastructure and interruptions in water supply exacerbate the situation. On the back of this, and together with growing urbanisation, water availability is a growing crisis.
From Johannesburg to San Francisco, to Delhi and Bangalore, there are examples in both the developed and developing world that indicate that to flush is becoming a luxury we can no longer afford. Not only does it take six to nine litres to flush a toilet, nearly 60% of household water consumption is used to transport human waste away. In water stressed environments this is a growing problem — a sanitation timebomb waiting to go off.
It is a sin that in today’s modern times, of growing water constraints, that we continue to flush away our waste. The Achilles’ heel is the lack of sanitation technology and innovation. The sector’s infrastructure-driven culture has blinded us from adopting and driving innovation and solutions.
We are still locked into a 200-year-old “Victorian” technology and this is one of the key factors in the poor and undignified sanitation in urban and rural settlements, rural schools, clinics, hospitals and households.
But this is not the only problem. We have seen reports of the disastrous consequences of the lack of operation and maintenance on modern sanitation systems — the sewers and wastewater treatment plants. The recent Green Drop report paints a bleak picture of the state of sanitation in South Africa and fixing this will take a lot of time and money.
Despite this, politicians continue to make promises that perpetuate this situation. Good examples are the developments in Campbell, Ogies and Emfuleni, to name but a few, which are very water stressed, yet full waterborne sewerage was chosen as the service delivery option. Many also fail to meet the Green Drop status.
Huge strides have been made in conventional waterborne sanitation but these come at a significant financial and energy cost. Climate change puts added pressure on the water resources available for flushing and transporting human waste. Today’s water crisis in the urban world is, in reality, a sanitation-sewerage crisis.
New sanitation technology is urgently needed. That is technology which can safely treat human excreta without the need for sewers, and has minimal reliance on external water, energy and one which has potential for beneficiation of waste streams. Through innovation and smart-chain supply, universal access can be achieved sustainably and link to water security and business opportunities.
This opportunity opens up solutions for growing urban and rural settlements in the developing world, as well as the water-starved developed world, to reduce water consumption, their carbon footprint and eliminate pollutant pathways.
New water-efficient sanitation solutions (WESS) are needed. These next-generation, climate resilient, off-grid, innovative and novel technological options for sanitation need to take into account available water and energy resources, user preferences and variable user populations and be able to contribute to revenue generation through beneficiation of waste products or reduce operational and maintenance costs.
Such interventions can potentially contribute to a 50% reduction in water used and supplied; huge savings on costs of sewers and resource-intensive traditional wastewater treatment systems; reduction or elimination of pollution pathways and a net reduction of non-revenue water as less water will be need to be supplied.
The further benefit offered by WESS is the potential for a sustainable new sanitation circular economy, which offers opportunities for job creation and social upliftment, as well as industrialisation, localisation and a new services industry.
Practical ways of entrenching WESS as part of the existing regulatory process, specifically pertaining to the proposed water and sanitation services norms and standards, the standard water-use licence application process and, ideally, also leveraging the concepts through the Blue and Green Drop incentive-based regulation assessments.
| Key opportunities | Key barriers |
| Efficient resource use in limited water resources and stressed water resource areas | Lack of prioritisation of WESS in regulation |
| Not adding to overstressed sewer networks and wastewater treatment systems | Lack of readily accredited water-efficient treatment technologies |
| Unlocking service extension and blocked bulk related projects | Ineffectual awareness creation and lack of readily available guidelines and standards |
| Having sanitation systems that are effectively designed to manage impact of climate change such as drought and floods | Reluctance to change |
Table : Key opportunities and barriers to entrenching WESS
To achieve this outcome, three approaches for WESS can be considered:
- Rapid adaptation and strengthening of existing regulations by identifying quick changes that can be adapted or strengthened to ensure efficient water use, and where possible, off-grid services form part of the sanitation solutions being investigated for new greenfield developments;
- Entrenching water-efficient sanitation solutions in department of water and sanitation regulations by identifying changes to existing regulations and guidelines or developing new regulations that entrench WESS as part of the sanitation solutions being investigated for all developments (brownfield and greenfield) and
- Entrenching water efficient sanitation solutions in sectoral regulation by strengthening regulations, guidelines and standards or developing new regulatory documentation.
Dr Jeniffer Molwantwa is the chief executive and Jay Bhagwan the executive manager at the Water Research Commission.
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