It should send a shiver down the spine of every South African to read of the deaths of the 94 psychiatric patients (The deaths now number over 100. -- blogs editor), which the Health Ombudsman's report has found were all –- but one -– entirely avoidable. What was the role of the relatives of the patients in the provincial government's decision to move the patients from the suitable Life Esidimeni facility to meet their fate in unlicensed and ill-equipped NGOs?
This country has developed a culture of non-involvement of affected persons in decision making by public representatives. "Non-involvement" in the sense that whatever participation might have taken place is usually not meaningful, and as such it is as good as non-participation. This nation has witnessed – and to some extent also become desensitised to –- service delivery protests. These protests peaked in the period between 2005 and 2006 when our national Parliament changed the Constitution and transferred communities, kicking and screaming, from some provinces into others (e.g Merafong from Gauteng into Northwest and Matatiele from KwaZulu-Natal into the Eastern Cape) in order to bring to an end cross-boundary municipalities.
Before the transfers took place meetings were held with the affected communities. Because the people were "consulted" on the decision to move them – one could also be so naïve as to suggest that the affected communities participated in the process; it would be reasonable to question why then were there protests afterwards? The same question can be asked of the implementation of the e-tolls in Gauteng as there were also consultations, with later consultations leading to reduced toll fares.
The reason for these protests, both around the decision to uproot communities in 2005 and 2006, as well as the boycott of the e-tolls by some Gautengers, is that there is no culture of meaningful engagement with members of society about decisions that affect them in South Africa. Consultation is often a sham, staged to comply with some rule and therefore a mere formality. It is usually designed to add a veneer of transparency and therefore legitimacy to a process. In this instance, you might well ask whether public participation in decision-making is ever meaningful.
This is not an easy question to answer, as what may be necessary to make citizen participation meaningful in one instance may not result in meaningful participation in another. James Ebbesson is very helpful here. He says that genuine public participation in decision making happens when citizens are afforded opportunities which enable them "to exercise meaningful choices..." For Sherry Arnstein, true participation results from a process where there is co-decision making, itself resulting from a partnership and some degree of citizen control over the process. This then enables the citizens to hold the authorities to account.
Co-decision making means that citizens' input is truly considered. In the context of the decision to move communities into new provinces against their will, meaningful public participation would have meant that the affected communities' objections to being moved would have halted the process. It would have meant a stop to the e-tolls in Gauteng. Furthermore, for the engagement to be meaningful, all the information on which the decision is to be based must be made available to the participants. The Constitutional Court puts so high a premium on meaningful engagement that it has held, that it might reject an eviction application as absent meaningful engagement.
The families would never have agreed to a decision to move their loved ones to unlicensed NGOs where they faced the prospect of being exposed to very cold winter nights, would be sharing pit-toilets for their sanitation needs and would on occasions go to bed without food.
Returning to the Esidimeni tragedy, it may very well be that there were consultations with the families of the patients on the decision to move their loved ones from Life Esidimeni to wherever the provincial health department had decided to take them. It is submitted here that the participation of the families in the process could not have been meaningful for a number of reasons.
For example, the families would never have agreed to a decision to move their loved ones to unlicensed NGOs where they faced the prospect of being exposed to very cold winter nights, would be sharing pit-toilets for their sanitation needs and would on occasions go to bed without food, and more frightening, would not receive their medication because staff at the NGOs did not know what medication they were on. In any event the provincial government would certainly not have revealed to the families during whatever consultation may have taken place that these were conditions awaiting their loved ones at the NGOs' facilities. So rushed and negligent was the process, apparently, that it is doubtful whether the provincial government knew the conditions awaiting the patients at the NGOs.
In conclusion, if the provincial government had cared sufficiently about the right to life of the mentally ill patients so as to involve the families in the decision to move their loved ones from the more comfortable conditions at Life Esidimeni to NGOs, such decision would have been met with stern objections without knowledge of the conditions awaiting their loved ones at the NGOs. Furthermore, if the families' participation in the decision was meaningful, it would have brought the process to a halt. Thus, in the circumstances of this case, meaningful engagement might have resulted in the whole tragedy being averted.