The management of a policy implementation project: the disastrous Gauteng Mental Health Marathon Project

Abstract

The widely reported disastrous Gauteng Mental Health Marathon Project caused the deaths of about 144 vulnerable individuals. The purpose of this contribution is to make sense of the latter by providing a chronological reconstruction of the main series of events. This is followed by a selection of the most appropriate theoretical lenses for identifying those implausible events and for comprehensively redrafting this narrative to gain understanding. The sensemaking approach was selected for the simplicity in guiding the sense-maker with naïve questions through the messy field of discrepancies. With this disastrous policy implementation project study in mind, we have asked: “Why do policy implementation projects become disastrous?” and “How can policy implementation projects be vision aligned?” As this specific case of policy implementation projects has been intensively and widely scrutinised in the public domain, we have relied nearly exclusively on publicly available material. In doing so, researchers acknowledge that there are numerous other perspectives and stories that we have not sourced and analysed. For the purpose of this sensemaking process, three interrelated lenses were used, namely the policy regime lens, the policy commitment lens and the political-administrative interface lens. However, we acknowledge that our selection and use of these theoretical lenses are not entirely exhaustive and adequate. This study has found that the all-inclusive national healthcare policy regime has been attenuated by the Gauteng Department of Health (GDoH) to the exclusion of the national policy intent and the wide variety of legitimate healthcare stakeholders. We have argued that the behaviour of the GDoH in this saga can be attributed, inter alia, to the situational theory of policy commitment. Furthermore, the study found that the relationship between the political office bearer and the Head of Department (HoD) in our case, was not at all equal and complementary; the Member of the Executive Council (MEC) overstepped in the sphere of public administration, while the HoD did not sufficiently execute his legal authority as accounting officer. Lastly, it was found that the operational project management process focused almost exclusively on removing the mental healthcare users from the Life Healthcare Esidimeni facilities before 30 June 2016, without evidence that those facilities to which they were transferred, would constitute the envisaged improved mental healthcare for them. This case study has shown that it is possible through retrospective sensemaking to creatively rectify the errors of the past and replace them with an envisaged future storyline.