As a paediatrician I specialised in childhood diseases of the gastrointestinal tract. I obtained a doctorate for a study of infants presenting to the Red Cross Children’s Hospital in Cape Town with acute diarrhoea. In the introductory chapter of my thesis, I quoted the researchers Rohde and Northrup (1975) who stated that, “the incidence of diarrhoea is more closely related to socioeconomic conditions than to climate, to poverty rather than place.” At that time (1981-1982) diarrhoea in infants was an annual summer epidemic in Cape Town located largely amongst the black and coloured communities of the Cape Flats. In recent times the frequency of the disease amongst children from these…
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André de Ruyter … Truth to Power … a must read!
I have just finished reading André de Ruyter’s book Truth to Power My Three Years Inside Eskom, which I believe should be read by South Africans interested in why the country is the way it is today. Unlike de Ruyter, I spent my whole professional life in the public sector, while he entered Eskom as the CEO having only worked in the private sector. He acknowledges that he completely underestimated the constraints imposed on him as the Eskom CEO by the public service regulations and processes as well as political oversight. As with de Ruyter when I moved from a clinical role in health services into management in 1994, I experienced…
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National Health Insurance in South Africa … will logic prevail?
Following my last post describing an analogy between the space shuttle disasters and the possibility of a system failure following the envisaged implementation of National Health Insurance (NHI) in South Africa my thoughts have returned to what I wrote in March 2022. This post reflected on the alternatives to what is proposed in the South African model of NHI. As I wrote then since 1994 the divide between those who have the ability to afford what in South Africa is termed private healthcare and those dependent on the State operated Public Health Service for the provision of healthcare has regrettably grown. The widening gap cannot be laid at the door…
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National Health Insurance … potential for system failure?
I recently read about the two disasters affecting the American Space Shuttles. The Challenger exploded shortly after launch in 1985 while the Columbia was destroyed 20 years ago over Texas on its 2003 return to earth after a 16-day mission. In both cases an accident investigation board (AIB) was established to investigate the causes of the disasters and make recommendations to address what had occurred. In the case of Challenger, a faulty o-ring on one of the solid rocket booster rockets, due to the abnormally cold weather during the launch, lead to flames leaking from the rocket igniting a catastrophic explosion in the shuttle’s external fuel tank destroying of the space…
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Politics, policy and implementation … there is a vast difference!
President Ramaphosa speaking at the 5th South African Investment Conference on 13th April 2023 made the following statements; “We are now confronted with the consequences of years of under-investment, mismanagement and corruption in our electricity, rail and logistics sector.” and that, “We are on a long journey to rebuild our country and recover ground we have lost. Our recovery is a mission and will take time to accomplish”. He continued that, “The lack of reliability in electricity supply weakens business and consumer confidence, taints international perceptions about our country and affects investment sentiment and decisions” concluding that, “If the focus of our struggle for liberation to end apartheid and achieve political freedom, the focus of our efforts must be to address inequality…
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Some thoughts on health service management
I am often asked what are the requirements to manage public health services or a public health facility? What qualifications are ideal? Is a health background essential? What about a health related MBA? I wrote on this topic in a post dated 21st December 2021 and if these are questions that still entertain you that post is worth another read. Previously my recommendations in that post were: Time spent in the health services either as a health professional or employed in another capacity within the health services is essential. Particularly, if one is not a health professional a postgraduate qualification in public health to provide an understanding of the field…
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Hospitals are key to an effective health service
Having recently been a patient requiring major surgery in a hospital, I have reflected on the vital nature of a fully functional hospital to the integrity of a health service. Despite spending half my professional life as a clinician working in a hospital, being a patient requiring complex care without which I may not have been here today to write this, provided me with another perspective. Hospitals, be they in the public or private health sector, are complex organisations focused on, and vital to the well being of the patients admitted to their wards. Hospitals are essential to provide a range of services that cannot be provided elsewhere which is…
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Livingstone Hospital … a case study worth analysing
A recent media report revealed that some patients admitted to Livingstone Hospital a large provincial hospital located in Gqeberha, Eastern Cape are apparently given a letter which reads as follows: You have been admitted to Livingstone Hospital because you require emergency/urgent treatment for an orthopaedic condition. Unfortunately, the implants (metal devices used to fix broken/deformed bones) needed to best treat you are not currently available in the hospital. Depending on your injury and the delay the implant unavailability causes, you might not be able to be treated surgically and have a poor result/outcome. Your doctors have not been informed when implants will again be available nor given any alternative hospitals…
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When is enough, enough?
As a health professional and health manager, it is understandable that most of what I write about is health related. But I am also a citizen of this country and live some of the realities that South Africans experience, albeit not fully experiencing what my less fortunate fellow South Africans experience. For this reason I reflect here, accepting that I am a privileged citizen of this country, on the general state in which South Africans find themselves. Whilst the abolition of apartheid removed discrimination on the basis of race, we are still a country divided along racial lines between those who have and those who have not. South Africans are…
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Gauteng Health Department woes are not new
In February 2017 after the release of the damning report by the Health Ombud Professor Makgoba on what happened subsequent to the disastrous transfer of mental health patients from Life Esidemeni to ill-prepared NPO’s, the then Minister of Health Dr. Aaron Motsoaledi and the then Premier of Gauteng David Makhura announced the appointment of a high-level task team to address what were termed “critical inadequacies in the capacities and capabilities and competencies to run the system and the management and incapacities exposed by the Life Esidimeni tragedy.” I was a member of that five-person task team for four months working in Gauteng. Ultimately I resigned in frustration as the team’s work…