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.
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
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.
Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/53117
This item appears in the following collections: Masters Degrees (Information Science)174