Lesson learnt in the implementation of PHC - Health Systems Trust

Structural Management and Support Services –
Cape Town Metro, Western Cape
1 Strengthening
the District
Health System
Approach
Following the recommendations of the rapid appraisal:
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A facility manager was appointed, together with administrative support
A facility management team was formed with the heads of sub-sections
An operational plan with key performance areas (KPAs) was drawn up. One of the KPAs was
to reduce patient waiting time
The facility manager attended a management course for improving service delivery to assist
with identifying operational problems such as bottlenecks in patient flow
A study on waiting times showed that the main bottlenecks were in the reception and the
pharmacy
The solutions to speed up service and reduce waiting time mainly involved changes in
scheduling for both patient flow and staff.
Problems arose in trying to implement these solutions. These fall into two categories: support services
and line management problems.
1. Support Service Problems
Procurement and Information Technology:
The implementation of plans for technical improvements to speed up service experienced excessively
long delays. This was due to a long bureaucratic procurement cycle and lack of efficiency from the
support services which are centralised at the metro head office.
Human Resources Management:
Reception staff resisted rescheduling to improve their efficiency. Certain employees continued to be
a disruptive influence and actively attempted to undermine the authority of the facility manager. The
next level of management at the metro office did not have the capacity to assist the facility manager
to discipline staff effectively.
The pharmacy posed the major bottleneck in patient waiting time. Rescheduling to allow the pharmacy
to stay open over lunchtime and to reschedule chronic patients to the afternoon was resisted. In
addition, poor staff discipline in the pharmacy was not effectively addressed by the HR section.
2. Line Management Problems
Various categories of staff (doctors, pharmacists, nurses, clerks) are technically supervised by a senior
member (e.g. chief pharmacist) of that category based outside of the facility. The problems caused by
such parallel lines of accountability contribute to and complicate the disciplinary cases and procurement
problems mentioned above. For example, when a doctor is performing poorly, this is addressed
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