Aaron Motsoaledi practises what he preaches. When he underwent surgery this year, he did so at a government hospital. The same is true for his family: he refused to allow his daughter to have her molars removed at a private hospital, and his children attend state schools.

There is high praise for the health minister`s successful antiretroviral (ARV) programme. He has steered it from a dysfunctional project to the biggest ARV treatment programme in the world. It provides lifesaving drugs to more than two million people. This year the minister introduced an all-in-one, single pill ARV, although some doctors say it has been rolled out badly, with various deadlines being missed.

Though Motsoaledi has been criticised for some of his policies, he has remained unfazed. This year he announced his intention to ban alcohol advertising in an effort to curb the effects of heavy drinking, and has signed regulations that will make it more difficult for the complementary medicine industry to sell scientifically untested medicines.

Though few doubt his passion and commitment to repairing the dilapidated public healthcare system, several key role-players are concerned that this lofty goal may be out of reach. Several critics say Motsoaledi has failed to implement important strategies to improve public health; others say he spends far too much time “firefighting”. And then there are those who say he should focus on two or three aspects of his 10-point plan to overhaul the health system rather than on trying to achieve all the goals simultaneously.

Motsoaledi failed to publish the long-awaited National Health Insurance system white paper this year and there appears to be little progress on the implementation of his policies at provincial and district level: there are regular cases of severe shortages of medicines and soaring maternal and infant mortality rates in provinces such as the Eastern Cape, Mpumalanga, Limpopo and the Free State.

Health activists argue that Motsoaledi lacks the political influence in certain provinces to persuade premiers to fire incompetent health MECs.

As one activist put it: “It`s ironic that we have the best health minister this country has ever seen yet our health system carries on deteriorating. Motsoaledi can make as many good policies as he wants but they`re of no use if he doesn`t have control over their implementation.”