The experience of hospital management and employees in transforming the public health system in the Western Cape 1996-2001

Mnyembane, Adiel (2002-12)

Thesis (MPhil)--Stellenbosch University, 2002.

Thesis

ENGLISH ABSTRACT: One of the main objectives of the new South African government who came into power in 1994 was to improve the daily living conditions of its citizens. To what extent did the government succeed in this objective? This is the basic research question informing the present study. In order to keep it within manageable proportions, the study investigated a very specific area of service delivery, namely the delivery of public health services. This was further narrowed down to the Western Cape and more specifically, to the role of public hospitals in the area. The Western Cape promised to be an interesting case, because although the government of national unity was dominated by the ANC, the Western Cape was ruled by a NNP dominated coalition. On the national level, the Province had to follow national policy guidelines, while on the provincial level it had more freedom to formulate and implement its own policies. The study itself consists of two parts. The first concerns policy formulation, the second policy implementation. As far as policy formulation is concerned, a study was made of basic documents articulating the fundamental values, national priorities and main objectives informing government policy. These included the Freedom Charter, the Constitution, and the Reconstruction and Development Program. It was found that these values and priorities were in general well translated into policy options on both the national and provincial level, especially in the various documents aimed at transforming the national health system. The second part of the study investigates the implementation of the broad policy guidelines in the area of public heath in selected public hospitals in the Western Cape. The main method of investigation was the use of structured interviews with representative employees from all different levels. The findings were therefore of a qualitative rather than a quantitative nature. The focal areas selected were personnel management issues, human resource planning, labour relation issues and human resource development issues. The main findings were that the formulation of policy both from basic values to the level of health care policies and from the national to provincial level in general was quite successful. On the other hand, there were serious shortcomings in the implementation of these policies on various levels. The investigation revealed a mixed and often contradictory picture. Although some hospitals made good progress in some respects, there is still a long way before quality health care will be delivered to all patients. A commitment to equity in the health services of the country implies a commitment to correcting the historical gender, class and racial imbalances in the development of human recourses for health care. Of necessity, a compassionate and caring health service will address the issue of corrective action. There is a real need to provide proper planning of those most disadvantaged by apartheid in managerial skills to fill managerial positions in the health sector. It is therefore is necessary to introduce as a matter of urgency new health management programmes, which will promote efficient and effectiveness management at all levels of health care service delivery. Current health managers need to be reoriented from the predominantly bureaucratic, rule-based approach towards a participative approach. The development of managerial capacity in areas such as participative and change management, leadership development, strategic planning, programme management and evaluation, and policy development and implementation is of crucial importance. The study concludes with a series of specific recommendations with regard to affirmative action, managerial and institutional capacity, human resource planning, and training needs for various sectors.

AFRIKAANSE OPSOMMING: Een van die hoofdoelstellings van die nuwe Suid-Afrikaanse regering wat in 1994 aan bewind gekom het, was om die leefomstandinghede van al die land se inwoners te verbeter. Tot watter mate het die regering geslaag in hierdie doelwit? Dit is die basiese navorsingsvraag onderliggend aan hierdie studie. Ten einde die ondersoek binne hanteerbare grense te hou, is op slegs een aspek van dienslewering gekonsenteer, naamlik die lewering van gesondheidsdienste. Hierdie terrein is verder vernou tot die Wes-Kaap en meer spesifiek tot die rol van openbare hospitale. Die Wes-Kaap was interessant omdat hoewel die regering op nasionale vlak deur die ANC beheer is, die Wes-Kaap basies deur die NNP in die periode van ondersoek geregeer is. Die provinsie was verplig om nasionale beleidsriglyne te volg, maar op provinsiale vlak het dit 'n sekere speelruimte geniet om eie beleid te formuleer en te implementeer. Die studie bestaan uit twee dele. Die eerste het te doen met beleidsformulering, die tweede met beleidsimplementering. Wat beleidsformulering betref, is 'n studie gemaak van die basisdokumente wat die kernwaardes, nasionale prioriteite en hoof doelstellings van die regering bevat. Dit het ingesluit die Vryheidmanifes, die Konstitusie en die Heropbou- en Ontwikkelingsprogram. Daar is bevind dat hierdie waardes en prioriteite in die algemeen suksesvol vertaal is in beleidsopsies op beide die nasionale en provinsiale vlak, veral in die dokumente wat gerig was op die transformasie van die nasionale gesondheidsektor. Die tweede deel van die studie het die implementering van die breë beleidsriglyne in die area van openbare gesondheid in geselekteerde publike hospitale in die Wes-Kaap ondersoek. Die hoof-ondersoekmetode was gestruktureerde onderhoude met verteenwoordigende werknemers van alle vlakke. Die bevindinge was gevolglik meer van 'n kwalitatiewe as kwantitatiewe aard. Die fokusareas waarop geskonsentreer is, was personeelbestuur, menslike hulpbronbeplanning, arbeidsverhoudinge en die ontwikkeling van menslike potensiaal. Die hoofbevindinge was dat die formulering van beleid beide van basiese waardes na gesondheidsbeleid en van die nasionale na provinsiale vlak in die algemeen suksesvol was. Aan die ander kant het ernstige gebreke aan die lig gekom sover dit die implementering van beleid op verskillende vlakke betref. Die resultaat was 'n gemengde en dikwels kontrasterende prentjie. Hoewel sommige hospitale goeie vordering gemaak het in sekere opsigte, laat die lewering van gehalte-diens aan alle pasiënte nog veel te wense oor. Die verbintenis to gelykheid in gesondheidsdienste veronderstel 'n verbintenis tot die regstelling van geslags-, klas- en rasse-ongelykhede in die ontwikkeling van menslike hulpbronne in die gesondheidsektor. Dienslewering gebaseer op sorg en empatie is van deurslaggewende belang in hierdie opsig. Daar is 'n groot behoefte aan behoorlike beplanning vir die verbetering van bestuur- en ander vaardighede van agtergestelde groepe. Die implementering van behoorlike bestuursopleidingsprogramme is van die uiterste belang, wat kan bydra tot effektiewe en goeie dienslewering. Die huidige oorwegend burokratiese en reëlsgebonde bestuurstyl behoort in 'n deelnemende benadering omgeskakel te word. Die ontwikkeling van bestuurskapasiteit in gebiede soos deelnemende veranderingsbestuur, leierskapsontwikkeling, strategiese beplanning, programbestuur en -evaluering en beleidsformulering is van die grootse belang. Die ondersoek sluit af met 'n reeks konkrete aanbevelings met betrekking tot regstellende aksie, verbetering van bestuurskapasiteit, menslike hulpbronontwikkeling en die opleidingsbehoeftes van die verskillende afdelings.

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