The more things change the more they stay the same Ah, is it just me or does anybody see The new improved tomorrow isn’t what it used to be Yesterday keeps comin’ ’round, it’s just reality … The words of a song by Bon Jovi echo in my mind as I reflect on the state of South African healthcare. The song itself echoes the words of the French writer Jean-Baptiste Alphonse Karr from the 1800’s who wrote that “plus ça change, plus c’est la même chose” – the more things change, the more they stay the same – indicating that turbulent changes do not affect reality on a deeper level…
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From policy pronouncements to implementation … a seemingly difficult path!
I was struck that many of the pronouncements by President Ramaphosa in the 2022 State of the Nation Address (SoNA 2022) are noble in intent but fail to address the mechanism by which policy pronouncements become a reality. While it is correct, as the President did, to allude to the consequences of State Capture and the COVID-19 pandemic that have set the country back, these alone cannot be the reasons why South Africa finds itself in the perilous position that it does today. In fact, from the Constitution down this country has some of the most progressive policies and legislation in the world but has failed in many areas to…
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The argument for meaningful debate.
In my book, “Walking the Road of Healthcare in South Africa”, I reflect on my experiences as a senior bureaucrat and what I term the “argument for meaningful debate”. A parliament is defined as a “formal conference for the discussion of public affairs” while a legislature is defined as “body of persons having the power to legislate or make laws”. My expectation of the deliberations in such a body or a committee of such a structure, was that there should be a meaningful debate with the exchange of logical and consequent ideas. However in my experience, meaningful debate is often a scarce commodity in the chambers of the South African…
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Life after the COVID-19 pandemic
The advent of the Omicron variant initially worrisome, and in various ways very damaging to the South African hospitality industry, has proved to be less serious than expected in terms of the health impact. Nevertheless there seems to be a reluctance on the part of health experts, to whom I referred in my last post, to now let go of their prime position in the media that they had occupied at the height of the pandemic and return to the less glamorous aspects of health care. A negative aspect of the pandemic aside from the direct consequences of the virus, has been the disruption of the wider ambit of health…
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COVID-19 … is there another approach?
A recent weekly press briefing by the Western Cape Premier Alan Winde to update the province on the COVID pandemic set me thinking and asking myself some difficult questions. With the advent of the Omicron COVID variant, countries around the world have reacted with further restrictions placed on their citizens. International travel for the average citizen has ground almost to a halt with disastrous consequences for the hospitality industry and the many other commercial entities dependent on this sector. Despite these new and draconian restrictions, almost impulsively implemented, the numbers of Omicron infections across the globe continue to rise. In South Africa where the Omicron variant was first identified, the…
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Health management … what do I need to be a health manager?
I was asked by a reader of one of my recent posts, what I regarded as the ideal preparation to become a manager of health services? The question was posed by a medical student about to graduate as a doctor and it set me thinking what is the best preparation for entering the field of health management? Given my background and experience I will focus primarily on a management career in the public health service. So here are my thoughts … I do not think that management of health services is the province of medical practitioners alone although for many years it was the case as evidenced by those who…
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Gift of the Givers and a Vaccine Task Force … lessons to be learnt
Recently it was reported that Gift of the Givers, a charitable organisation, has been distributing food to hospitals in the Eastern Cape. This was reportedly due to the provincial health department being unable to ensure adequate food supplies to patients due to what was termed a “budget shortfall”. If even partially true it is an iniquitous situation for State hospitals to find themselves and begs the question, why has it come to this? I have written on many occasions that we should expect greater accountability from those responsible for the management of health departments in this country. This is not the first time the unacceptable conditions in Eastern cape Hospitals…
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Accountability … measuring performance
A recent post elicited a request, “Please share your thoughts on how you see the importance of performance data in accountability”. I make no claim to have expertise in the theory and science of performance management but accountability is undoubtedly linked to measures of performance. As is my wont, I went to the dictionary for the a definition of the verb, “account” and found “to furnish a justifying analysis or justification”. It follows thus that accountability is the state of being accountable i.e subject to giving account. In my initial post I had listed accountability as a characteristic of good governance. I used the word more in an ethical sense…
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Endless meetings and Life … Reflections on a poem
The poem translated from the original Portuguese is attributed to a Brazilian poet, Mario de Andrade, although there is some doubt if he was the author as there is indeed regarding the title of the poem, “My Soul has a Hat” “I counted my years and realized that I have less time to live by than I have lived so far. I feel like a child who won a pack of candies. At first, he ate them with pleasure, but when he realized that there was little left, he began to taste them intensely. I have no time for endless meetings where the statutes, rules, procedures, and internal regulations are…
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Thoughts on Governance and Leadership … what has gone wrong?
I have not posted on Househam on Health for some time for two reasons. Firstly, as with many others I am sure, I have been shocked, disillusioned and depressed by the scandal that has unfolded at the highest level in the South African public health sector. Secondly, I have been engaged in a project to assess financial management in a provincial department in South Africa which has been both an interesting and challenging experience. These events have led me to reflect again on a question that I was asked some time ago and one that I have asked myself many times. What are the differences between a department of health…
