5 October 2004
In an article, "Give state hospitals a dose of autonomy", the Democratic Alliance health spokesman Ryan Coetzee outlines what he regards as fundamental rethinking of the public hospital management approach which is simply a resuscitation of the DA's 2004 election manifesto on health.
The proposals, which were duly rejected by the South African electorate, are based on the poor understanding of the public health sector and the progress made over the past decade. The author correctly concludes that his ideas need a validity test and ironing out of "problems that may arise" if they are implemented.
Numerous studies conducted a few years ago revealed a significantly high level of inefficiencies in our hospitals. The main contributing factor was the archaic management structures and systems of the past.
The Department of Health initiated a decentralisation programme leading to a shift in the functions of provincial health authorities from an executive or administrative management role to supporting hospital management, setting guidelines and provincial policy approach. Provinces are developing innovative strategic plans to address the health needs of the people they serve within broad national guidelines. Seven of the nine provinces have written delegation of powers devolved to a hospital level and the remaining two provinces are at an advanced stage of finalising these delegations.
Decentralisation allows hospital management flexibility to spend the allocated budget to achieve high standard of service delivery. General management structures have been introduced to ensure proper management of hospitals along business principles. We have moved away from the concept of medical superintendents to appointing appropriately qualified and competent managers to run public hospitals.
With the change in our management structures, we are beginning to see a more integrated management approach that seeks to address the overall challenges of a health facility and improve competitiveness. Recently, Johannesburg Hospital - a public hospital - got the most votes in the Star Readers Awards beating "the highly regarded" Sunninghill Hospital, which came second.
The decentralisation process is complemented by the Hospital Revitalisation Programme which does not only improve the hospital infrastructure, but also provides necessary equipment and boosts management capacity. Since 1998, R1.6 billion has been spent on 249 projects. The current annual budget of R717 million for the programme is expected to increase to R1 billion in 2005/2006 financial year.
While decentralisation increases autonomy and decision making powers of hospital managers, it also requires clearer lines of accountability to communities and compliance with set quality standards. Compliance with quality standards is one of the main conditions for the issuing of the certificate of need required for operating both public and private health establishments in terms of the new National Health Act no. 61 of 2003.
The Act also requires the establishment of representative hospital boards and clinic committees, which will ensure greater public participation and responsiveness to local health needs.
The Act provides a framework for a structured uniform health system with a common goal to improve universal access to quality health services. It rests heavily on the provision of the Constitution, which requires the State to take reasonable measures to progressively achieve the right to access to health care services.
The DA has opposed most of these measures to improve efficiency and quality and voted against the National Health Act, which replaces the last vestige of apartheid in health policy - the Health Act of 1977. As a member of the parliamentary portfolio committee on health, I would have expected Coetzee to acknowledge recent developments in the management of public hospitals before making his invalid suggestions.
Dr Manto Tshabalala-Msimang
Minister of Health