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A deserved commendation to a global trailblazer: Professor Malegapuru William Makgoba – South Africa’s Health Ombud

Health Ombud, Prof. MW Makgoba

A notable global trailblazer, Professor Malegapuru William Makgoba who was appointed as South Africa’s first Health Ombud entrusted with the responsibility to oversee and protect the wellbeing of the nation’s patients and healthcare users was recently nominated and commended by the judges of six (6) for the coveted prestigious John Maddox Prize now in its eighth year of running. The Health Ombud, is currently functionally located in the Office of Health Standards Compliance (OHSC), a health regulatory body created to promote and protect the health and safety of users of health services in South Africa. The John Maddox Prize is a joint initiative of the Charity Sense about Science that promotes the public interest in sound science and evidence globally.

The prize went to the forest fire expert, Professor Bambang Hero Saharjo and pharmacist Olivier Bernard. This prize commemorates, Sir John Maddox, who was a passionate and tireless champion and defender of science, he initiated and engaged in difficult debates and inspired others to do the same for the benefit of the public. As a writer and editor, Sir John Maddox changed attitudes and perceptions, and strove for better understanding and appreciation of science throughout his long working life. The winner of the Sir John Maddox Prize received £3000, and an announcement of the winner is published in Nature. For the 2019 Prize, 208 nominations were received from 38 countries.

As part of the nominations for the 2019 John Maddox Prize, the judges recognised and commended the ‘extraordinary contribution made by the Health Ombud, Professor Malegapuru William Makgoba, acclaimed for his challenge to AIDS denialism in South Africa, went on to expose and improve the treatment of mentally ill patients in South Africa’. The recognition of Professor Makgoba’s contribution as a physician, academic and contribution in various intellectual and policy debates, all premised in the common thread of respect for the Constitution, human rights, human dignity, access to healthcare and defence of the freedom of scientific expression. ‘It is important to appreciate I took the stance against AIDS denialism 20 years ago even before the introduction of the John Maddox Prize.

Professor Makgoba has occupied various high-profile positions in the country. During his term as the President of the South African Medical Research Council (SAMRC) which was at the height of AIDS denialism, the ‘SAMRC Report on the Impact of HIV/AIDS on Adult Mortality in South Africa was released and provided scientific evidence that people, particularly young men and women were dying from HIV/AIDS.  In May 2000, he wrote an editorial article for the journal, Science titled: ‘The Peril of Pseudoscience,’ he challenged and confronted HIV/AIDS denialism directly, using evidence-based practice and science. Despite overwhelming evidence confronting AIDS denialism at the time, the South African government adopted the official stance that HIV does not cause AIDS. Professor Makgoba took a very vocal and public stance against this disastrous policy option, which, some researchers estimated, cost over 350 000 of avoidable deaths.

“I’ve never felt that I was more needed to save the lives and the dignity of people than during that period of AIDS denialism,” he said. A comment by Justice, Edwin Cameron regarding Professor Makgoba’s role in fighting AIDS denialism deserves repeating as a lesson never to be forgotten by the country: “The clarion voice of truth-speaking amidst the siren clamour of unscientific waywardness earned Professor Makgoba few friends in the political establishment. But it enhanced his standing as a medical scientist faithful to his discipline and to canons of scientific inquiry. In taking this stand, Professor Makgoba occupied a unique position in South African public life”.

His professional eminence in the field of immunology, his profile as a public intellectual, and his passion for the truth combined to an extraordinary degree at a moment in which a nation searched for answers.  As if this wasn’t enough to secure his place as champion in the fight against HIV/AIDS denial and refusal by the Government then to provide anti-retroviral therapy (ARVs), his contributions to the body of South Africa’s research in the field surely does. Using relationships formed while abroad, Professor Makgoba was instrumental in securing major international funding to establish the Africa Centre and the KwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH), a local and global Tuberculosis and HIV research institute in South Africa funded by the Welcome Trust and the Howard Hughes Medical Institute, respectively.

Apart from his stance against AIDS denialism, Professor Makgoba went on to reveal neglect around mental health with the ultimate objective to improve the plight and treatment of mentally ill patients in the country through systematic investigations of Life Esidimeni tragedy and Tower Psychiatric Hospital and Psychosocial Rehabilitation Centre. “Nothing could be more rewarding for a health professional than being commended for improving the treatment of patients; that is what we train and work towards,” remarked Prof Makgoba.

Through his investigation of the Life Esidimeni tragedy through a complaint lodged by Section 27 and the former Minister of Health, Dr. Aaron Motsoaledi; he brought into sharp focus the neglect of patients with chronic mental health disease and the associated litany of human rights violations associated with mental health services in South Africa. The findings and recommendations of the Report accessible from: played a critical role in holding public office bearers accountable and responsible for their decisions and actions. The Life Esidimeni investigation and tragedy represented the largest human rights violation disaster in post-apartheid democratic South Africa second only to deaths associated with HIV/AIDS denialism.

The Life Esidimeni investigations won Professor Makgoba an award for ‘service excellence in creating access to healthcare’ at the 19th Board of Healthcare Funders (BHF) Conference held at Sun City Superbowl in June 2018. These accolades were the results of teamwork that included expert panels in the field of mental health and public health experts, OHSC inspectors and investigators. The major achievement from the Life Esidimeni report is certainly the improvement of mental health care services in the country.

“Mental Health Disorders are an epidemic waiting to explode in the world, if not properly planned for and addressed. It is important to properly plan in human and financial resources to improve the services, research and lives of mental health patients in the country as this cohort is often voiceless, vulnerable and stigmatised in most societies,” said Professor Makgoba.

The Health Ombud welcomes and supports the publication of the National Health Insurance (NHI) Bill as an indication of sustained progress towards the implementation of universal health coverage. The provision of universal quality healthcare is long overdue and is a ground-breaking step in the transformation and delivery of the national health system in South Africa. We should all unite behind the NHI Bill to all commit to do that which is right and just and is consistent with our Constitution. In passing the NHI Bill, we as the country re-affirm the National Development Plan objective of a long and healthy life for all and further lay the foundation for a better, brighter and stronger South African nation of the future. The passing and implementation of the NHI Bill is what matter most, and we must stop pussyfooting,” said Professor Makgoba. The Office of the Health Ombud will play its meaningful role within the NHI.

Professor Makgoba is not strange to accolades. The work of the Health Ombud continues to make significant impacts on the National Health System and beyond borders and the Office was recently admitted as a member of International Ombud Institute.

Professor Makgoba is a Fellow of the Royal College of Physicians of London; an Associate Foreign Member of the National Academy of Medicine of the USA; and Fellow of Imperial College (Faculty of Medicine). He is one of the Science Legends of South Africa. He has over his professional career through his hard work acquired a collection of accolades recognising him nationally and internationally as a pioneer in Science and Medicine. He was awarded the National Order of Mapungubwe (Silver) for ‘his dedication and excellent contribution to the field of science and medicine, locally and internationally, and for his contribution to the building of democracy in South Africa. He is an outstanding academic and a pioneer of transformation in higher education’.

Combined with the CAPRISA initiative funded by the National Institutes of Health (NIH), all located in KwaZulu-Natal, an area of high HIV/AIDS prevalence, these institutions represent possibly the largest coordinated HIV research effort in the world.

With all these accolades, Professor Makgoba remains humble about his success: “There were challenges in terms of the health system of the country that related to what I would call my passion, and of course when you do these things that require big money, people must trust you. I enjoyed the trust of my colleagues that I had worked with abroad, and I used that to the advantage of the university.”

If there’s one other thing Professor Makgoba will forever be remembered for, is his passion for transformation in higher education in South Africa. “Since my arrival from the United Kingdom (UK) in South Africa,” he says, “part of my success story has been the transformation of research institutes and higher education institutes; it defines who I am.”

After he retired as Vice-Chancellor of the UKZN, he continued with his passion to pursue the transformation agenda as Chair of the Transformation Oversight Committee of Public Universities. He is also the Deputy Chair of the second National Planning Commission, having served on the first Commission since 2010 under then Minister Trevor Manuel.

I am grateful to all the many people I worked with over the years; some cared, others supported and yet others guided me along the way. I am more grateful to my family who constantly love and care, live with and tolerate my ‘madness’ and ‘idiosyncrasies’. I am grateful to Sense about Science and to the judges of the John Maddox Prize for this humbling and inspirational commendation.