In 2023 in my health blog I described the budget shortfalls facing most South African government departments. From my perspective the most pressing consequences of these shortfalls are those affecting provincial health departments. Recent developments including an open letter addressed to the Minister of Finance from health professionals in the Western Cape have again highlighted this issue. Many provincial health departments in South Africa have a history of what are euphemistically termed “accruals”, which stated otherwise is an inability to settle outstanding accounts within either the required 30 days or even a financial year. These departments have in the past been unable to remain within their approved budgets. An implication of “accruals” is…
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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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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…
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Does quality healthcare depend on money alone?
Recently I met with the management of a health department as part of my work in the healthcare field. I arrived early at the venue located in a large hospital and as the meeting also commenced later than scheduled, I had time to walk around the hospital. I encountered various staff members and patients and was cordially greeted although none asked whether they could assist me or what I was doing in the hospital. What was striking was the dilapidated state of many areas of the facility. Paint peeled from the walls and there were signs of water damage to the ceilings in various places. A pane of glass was…
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A personal reflection …
I have not posted anything since July 2022. This is not because there has been nothing worthy of comment in the health sector but rather that I have felt a deep sense of despair with what has transpired in the preceding months and years. Since my retirement in 2015 I have been involved in various initiatives to address challenges in the South African public health service as a member of nationally appointed task teams and most recently as a consultant requested to address financial management in a South African provincial health service. Whilst I accept that as an outsider and consultant not directly responsible for the management of health services,…
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Walking the Road of Healthcare in South Africa now available on Amazon
I am glad to inform readers and subscribers to this page that my book published last year by Quickfox Publishers is now available on Amazon Books in either Kindle ebook or hard copy versions. In recent posts on this site I have referred to the book and I feel that what I have chronicled in the book remains relevant to the discourse on the future of healthcare in South Africa and elsewhere. I can also recommend the book to those who are either embarking on a career in health management or already in the thick of the challenges that such positions bring. I am glad that the book now has…
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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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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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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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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…