Futures for viable healthcare models for South Africa

Annandale, Martin Deon (2010-12)

Thesis (MPhil)--Stellenbosch University, 2010.

Thesis

ENGLISH ABSTRACT: The purpose of this study was to identify possible viable future healthcare models for South Africa, using the techniques and methodologies advocated in the field of future studies by futurists and erudite academics such as Ackoff, Drucker, De Jouvenel, Slaughter, Dostal and Roux. This topic necessitated a problem-orientated approach to future studies based on the complexities inherent thereto. A great deal of emphasis was therefore placed on the tools of rational analysis, which are supported by unregarded worldview assumptions about the ability of humans to regulate and control the world and therefore the framing of new laws, rules and regulations. The forward view was generated by using the appropriate methodologies such as environmental scanning and the analysis of trends and outcomes. Enrichment to the foresight work, beyond the respective models, was furthermore achieved by acknowledging the cultural and social-political arena wherein the current healthcare models in South Africa operate. The focused scan of salient and credible material and publications was extended to include research into healthcare outcomes achieved in countries with comparable economic and demographic profiles to South Africa. Supplementary research was also conducted into comprehensive aspects such as ethics and health economics in conjunction with recognised international healthcare models. The drivers of quality healthcare at primary and secondary healthcare levels and therefore also representing the constraining factors in the South African milieu being available healthcare practitioners, training, physical infrastructure, technology, access to facilities and the affordability of healthcare were explored to ensure the viability of the futures healthcare models contemplated. The identification of probable futures was accomplished by means of scenario development which focussed on the critical uncertainties of healthcare funding models and nationalisation as opposed to free market models competing for available resources in a semi-regulated environment. Thereafter Delphi techniques were used to acquire consensus from specialists currently working in the field of public and private healthcare along with stakeholders such as leaders of enterprise, healthcare funders and regulators as regards the identification of preferred future healthcare models that will meet, in a sustainable manner, the constitutional right to basic healthcare and enhance the quality of life and life expectancy of all South Africans. The relevance and credibility of the consensus opinions of the selected experts who participated in the research was again tested against the futures discourse publicised in the press to ensure that personal, cultural and organisational factors were not disregarded in the process. The study concluded on the fact that additional research and debate are required to ensure that the societal, organisational and individual aspects of the system wherein healthcare operates are comprehensively addressed by all relevant stakeholders in a manner that void of the neuroses caused by anxiety when thinking of the future.

AFRIKAANSE OPSOMMING: Die doel van die studie was om moontlike volhoubare toekomstige gesondheidsorgmodelle vir Suid-Afrika te identifiseer deur gebruik te maak van tegnieke en metodologieë soos voorgehou deur deskundiges en hoogs belese akademici in die veld van toekomstudies, soos Ackoff, Drucker, De Jouvenel, Dostal en Roux. Die studie het, as gevolg van die kompleksiteit daarvan, ´n probleem-gerigte benadering tot toekomstudies verlang. Gevolglik is baie klem geplaas op rasionele analise-tegnieke, wat ondersteun word deur wêreldsiening-aannames aangaande die mens se vermoeë om die wêreld te reguleer en te beheer deur middel van nuwe wetgewing, reëls en regulasies. Die toekomsgerigte siening is gegenereer deur die gebruik van toepaslike metodologieë, soos byvoorbeeld omgewingskandering en die analise van tendense en uitkomste. Die toekomsgerigte werk is aangevul deur erkenning te gee aan die kulturele en sosio-politiese milieu waarbinne die huidige gesondheidsorgmodelle in Suid Afrika funksioneer. Die gefokusde skandering van kredietwaardige bronne en publikasies is uitgebrei ten einde navorsing oor gesondheidsorguitkomste, soos behaal in lande met vergelykbare ekonomiese en demografiese profiele, soos Suid Afrika, in te sluit. Aanvullende navorsing is verder onderneem en was gerig op omvattende aspekte soos etiek en gesondheidsekonomie, tesame met erkende internasionale gesordheidsorgmodelle. Die kernbepalers van kwaliteit-gesondheidsorg op primêre en sekondêre gesondheidsorgvlak, wat dus ook die beperkende faktore in die Suid-Afrikaanse milieu verteenwoordig, naamlik beskikbaarheid van mediese praktisyns, opleiding, fisiese infrastruktuur, tegnologie, toegang tot fasiliteite en die bekostigbaarheid van gesondheidsorg, is ondersoek ten einde die volhoubaarheid van die toekomsgesondheidsmodelle te verseker. Die identifiserings van waarskynlike toekomste is bereik deur scenario-ontwikkeling wat gefokus het op die kritiese onsekerhede van gesondheidsorgbefondsing en nationalisering, teenoor ´n vryemarkstelsel wat meeding om beskikbare hulpbronne in ´n deels-gereguleerde omgewing. Daarna is Delphi-metodieke gebruik om konsensus te verkry onder kenners wat tans in die veld van openbare en privaat gesondheidsorg werksaam is, asook belanghebbendes soos leiers in besighede, gesondheidsorgbefondsers en reguleerders, ten opsigte van voorkeur-toekomsgesondheidsorgmodelle wat op ´n volhoubare wyse die grondwetlike regte tot basiese gesondheidsorg en die verbetering van die kwaliteit van lewe en lewensverwagting van alle Suid-Afrikaners sal bevorder. Die toepaslikheid en geloofwaardigheid van die konsensusmenings van die gekose kenners wat deelgeneem het aan die navorsing is weer getoets teen toekomsgesprekke soos gepubliseer in die media ten einde te verseker dat persoonlike, kulturele en organisatoriese faktore nie in die proses misken is nie. Die studie het tot die slotsom gekom dat verdere navorsing en debat nodig is ten einde te verseker dat die sosiale, organisatoriese en individuele aspekte van die stelsel waarbinne gesondheidsorg funksioneer omvattend aangespreek word deur alle belanghebbendes, en op ´n wyse wat enige neurose wat tot angstigheid oor toekomsdenke kan lei, die hok slaan.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/17466
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