The experience of hospital management and employees in transforming the public health system in the Western Cape 1996-2001

[摘要] ENGLISH ABSTRACT: One of the main objectives of the new South African government who came into powerin 1994 was to improve the daily living conditions of its citizens. To what extent did thegovernment succeed in this objective? This is the basic research question informing thepresent study. In order to keep it within manageable proportions, the study investigateda 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 roleof 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, theWestern Cape was ruled by a NNP dominated coalition. On the national level, theProvince had to follow national policy guidelines, while on the provincial level it hadmore freedom to formulate and implement its own policies.The study itself consists of two parts. The first concerns policy formulation, the secondpolicy implementation. As far as policy formulation is concerned, a study was made ofbasic documents articulating the fundamental values, national priorities and mainobjectives informing government policy. These included the Freedom Charter, theConstitution, and the Reconstruction and Development Program. It was found that thesevalues and priorities were in general well translated into policy options on both thenational and provincial level, especially in the various documents aimed attransforming the national health system.The second part of the study investigates the implementation of the broad policyguidelines 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 withrepresentative employees from all different levels. The findings were therefore of aqualitative rather than a quantitative nature. The focal areas selected were personnelmanagement issues, human resource planning, labour relation issues and humanresource development issues.The main findings were that the formulation of policy both from basic values to thelevel of health care policies and from the national to provincial level in general wasquite successful. On the other hand, there were serious shortcomings in theimplementation of these policies on various levels. The investigation revealed a mixedand often contradictory picture. Although some hospitals made good progress in somerespects, there is still a long way before quality health care will be delivered to allpatients. A commitment to equity in the health services of the country implies acommitment to correcting the historical gender, class and racial imbalances in thedevelopment of human recourses for health care. Of necessity, a compassionate andcaring health service will address the issue of corrective action. There is a real need toprovide proper planning of those most disadvantaged by apartheid in managerial skillsto fill managerial positions in the health sector. It is therefore is necessary to introduceas a matter of urgency new health management programmes, which will promoteefficient 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 managerialcapacity in areas such as participative and change management, leadershipdevelopment, strategic planning, programme management and evaluation, and policydevelopment and implementation is of crucial importance.The study concludes with a series of specific recommendations with regard toaffirmative action, managerial and institutional capacity, human resource planning, andtraining needs for various sectors.

[发布机构] Stellenbosch University