Now in my 73rd year, I have the benefit of looking back on decisions that affected the direction of my life. As a schoolboy, I was attracted to the law but a strong dislike of Latin, then a requirement to study law, lead me to enrol as a medical student. Many years later with a successful career as a paediatrician in academia, the politics of South Africa lead me to change direction and move into health management after 1994. Twenty years later, I ended my management career, retiring as the Head of the Western Cape Department of Health. An unplanned course but as the title of my valedictory address delivered…
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Successful healthcare delivery … a missing link could be Logistics
The term “Logistics”is defined in the Merriam-Webster Collegiate Dictionary as “the aspect of military science dealing with procurement, maintenance and transport of materiel, facilities and personnel” or stated otherwise “the handling of the details of the operation”. While the term was initially used in a military sense, the term is now used widely in commerce, to refer to how resources are handled and moved along the supply chain. A brief scan of the internet reveals a multitude of universities offering under-graduate and post-graduate degrees in logistics and logistics management. Promoting these courses universities encourage prospective students that embarking on the these courses will prepare them for a successful career in…
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The Road to Better Healthcare … we are at a crossroads.
Following my last post, I have been reflecting further on the failures in public health care in South Africa since 1994. In doing so I reread a book, “Yenza – a blueprint for transformation”, published in 1998 that has been on my bookshelf since then. I worked with the author, Dr. Piet Human, on several occasions during the early days of my time as Head of the Free State Department of Health. Read some twenty years later, the optimism, idealism and hope of the years immediately after 1994, reflected in the book, are poignant given what has transpired since. The opening sentences of his book read as follows: “The present…
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Learning Lessons From The Past 25 years
Why are the public health services in a perilous state in many areas of South Africa? These shortcomings have been brought into sharp focus by the impact of the COVID-19 pandemic. It is true that in 1994 at the time of the democratic transition in this country, that the health services bore the scars of decades of racial segregation. Hospitals and clinics were divided along racial lines with facilities for patients of colour inferior to those available to white patients. When I moved into health management in 1995 as Head of the Free State Department of Health, this difference was a stark reality. It was mirrored by the realities experienced…
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Command or Persuade … How people are influenced
In my previous post I argued against the imposition of further “lockdown” measures to address the rising number of COVID-19 cases in areas of South Africa. This has seemed to be a dissenting view when compared to what is the reported policy direction of government to address the resurgence of COVID-19 in areas of South Africa. I was, however, encouraged to read an article “Call to Action: A people-centred approach to disease prevention in the era of COVID-19” published in the Daily Maverick of 30th November 2020 penned by Yogan Pillay and Tracey Naledi. The article echoes many of the sentiments that I have expressed in articles over the preceding…
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The Difficult Dilemma of COVID-19 in our 2020 World!
I write this article as a 72-year old man with hypertension well-controlled on antihypertensive medication and as such an individual who falls into the group of individuals at higher risk for a more complicated course of COVID-19 should I acquire that infection. I am also a doctor and spent my professional life as both a practicing specialist clinician and a manager of health services. The reason for my stating this at the outset will become apparent to the reader. In South Africa the surge of COVID-19 cases and COVID-19 associated deaths overall first peaked around July of this year, 2020, and subsequently declined. Prior to the surge the country went…
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Decision Making in Government … the good and the bad!
I have just finished reading the book written by John Bolton, “The Room Where It Happened”. Bolton was the National Security Advisor of the United States and worked closely in this position with President Trump. It is a startling analysis of how decisions were made or not made at the highest level of the United States Government during his relatively short term of just over a year as the National Security Advisor. While a number of books have been written reflecting the experience of working with President Trump, this book is unique in that it reflects the experience of a political insider, a person who previously had held senior positions…
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“Accountability” essential for a successful nation!
“Accountability” as defined in the Merriam-Webster dictionary is “the quality or state of being accountable i.e. an obligation or willingness to accept responsibility or to account for one’s actions”. My professional training as a doctor made me aware of my accountability for my actions as a health professional. Accountability directly to my patient, a child in my case as a paediatrician, their parents and extended family. Accountability to the professional body with which I was registered to practice as well as to my employer, a public sector health department and university. Later when I moved into health management in 1995, I became legally accountable in terms of the Public Finance Management Act…
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Quality … the Holy Grail often sought but never found?
I have just finished reading “Zen and the Art of Motorcycle Maintenance” for, I think, the third or fourth time. The book, subtitled, “An Inquiry into Values”, has little to do the motorcycle maintenance other than in an allegorical sense but rather explores the journey of the author Robert Pirsig in pursuit of understanding the meaning of “Quality” against the background of a two week motorcycle trip across America from Minneapolis to San Francisco. The author of this unique book and best seller over the last forty years was committed to a mental institution earlier in his life, probably with a form of catatonic schizophrenia and subjected to electro-convulsive therapy…
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Leadership or management … the challenge of making decisions
I have been reflecting on the challenges President Ramaphosa faces in dealing with the COVID-19 pandemic and his struggle to match the need to consult widely and the need to take decisive decisions that have and will affect the lives of so many. Leadership, irrespective of position, requires the ability to motivate people and take an organisation in a given direction possibly different from that which it had previously taken. Management on the other hand involves systems and processes that allows an organisation to function efficiently and achieve its goals and objectives. Both expect those involved to act in an ethical and honest manner. This lead me to think about…
