sahr2001 - Health Systems Trust

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To enable hospital managers to manage more effectively a range of issues need to be addressed. These include: delegating more authority and responsibility to these managers; creating more effective management structures and systems; improving the organisational culture of hospitals and the health department as a whole; providing more resources like equipment and improving the infrastructure; capacity building, especially in financial and human resource management; and the provision of incentives for managers to manage effectively. Conclusions While it is important to hear the voices of politicians and managers, it is equally important to hear the voices of front line health workers. These voices may feature in next year’s Review. Most of the managers and politicians who were interviewed were clearly pleased to have been part of the transformation process. They are dedicated to strengthening the public health service and displayed their dedication by working long hours and largely being able to cope with the stresses of transformation. These stresses range from successive waves of transformation, lack of effective management systems and often lack of management skills to ensure implementation of policies that were often determined at national and provincial level. The interviews revealed that newly appointed managers were enthused with the opportunity to make a difference, but often did not fully understand the complexities of governing and managing change. In addition, they often had to implement radically new policies without the necessary skills and support. As one manager put it: “One sobers down after a while, you realise that you can’t change the world, because there are a lot of other things to cope with.” Many of the managers interviewed loved working in the public health sector. This is illustrated by a series of quotes used in this chapter and elsewhere. However, the work is hard and extrinsic rewards perceived as being few in number. The leadership of the public health sector needs to build on the enthusiasm of managers and others that work in the public sector by providing leadership and the necessary rewards. In addition to setting the vision, strategy and targets, the health leadership must work harder on being a ‘soft manager’. As Peace 3 suggests: “Soft qualities like openness and sensitivity are as critical to success as harder qualities like charisma, aggressiveness, and always being right”. One thing is certain, strengthening the public health system is not a short term job. It demands persistence, passion and commitment. Many managers display these characteristics but these qualities need to be nurtured by all of us who have an interest in ensuring that the public health sector provides effective and high quality care at an affordable cost to those who depend on it. 280
16 • Voices of <strong>Health</strong> Policy Makers References 1 Merriam-Webster’s Collegiate Dictionary. www.m-w.com. 2 Kotter JP. What leaders really do. Harvard Business Review, December 2001, pg 86. 3 Peace WH. The hard work of being a soft manager. Harvard Business Review, December 2001, pg 102. Acknowledgements This chapter could not have been written without the individual reports included in this volume. In addition, to the authors of the separate reports, I wish to thank the interviewees who, despite the demands on their time, lent us their time and voices. 281
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NORTHERN PROVINCE GAUTENG MPUMALANG
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Foreword Among significant events t
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14 Voices of National and Provincia
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Preface Listening to ‘Voices’
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an urgent need to improve the curre
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Transformation “Things happen so
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Introduction Health legislation is
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grounds. This was driven by the nee
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statutory powers in terms of the FA
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ecommend that the Minister make reg
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the expansion of their programme to
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Health Services are provided for in
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of a circumcision operation and the
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References 1 Report by the Joint Mo
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Introduction The District Health Sy
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(viz. environmental health services
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district’. This arrangement of su
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To illustrate the progress made tow
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References 1 Department of Health.
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Eastern Cape Category A and C Munic
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Gauteng Category A and C Municipali
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Mpumalanga Category A and C Municip
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Northern Province Category A and C
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Western Cape Category A and C Munic
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2 • The District Health System Ap
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Financing Local Government Health S
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3 • Financing Local Government He
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Private Sector Financing 4 Jane Gou
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Public-Private Partnerships 5 Julia
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Using Information for Health 6 Loui
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Annual Reports and the Public Finan
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HIV/AIDS Financing 8 Paul Whelan In
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8 • HIV/AIDS Financing discussed
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8 • HIV/AIDS Financing Provincial
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8 • HIV/AIDS Financing Funds to p
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8 • HIV/AIDS Financing have short
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8 • HIV/AIDS Financing plans requ
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8 • HIV/AIDS Financing district H
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8 • HIV/AIDS Financing The fundin
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8 • HIV/AIDS Financing Gauteng: G
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8 • HIV/AIDS Financing condoms, a
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8 • HIV/AIDS Financing Conditiona
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8 • HIV/AIDS Financing Financial
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Mainstreaming HIV/AIDS Progress and
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9 • Mainstreaming HIV/AIDS magnit
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9 • Mainstreaming HIV/AIDS Figure
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9 • Mainstreaming HIV/AIDS from t
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9 • Mainstreaming HIV/AIDS The sy
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9 • Mainstreaming HIV/AIDS Preven
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9 • Mainstreaming HIV/AIDS the im
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9 • Mainstreaming HIV/AIDS 8 Kiro
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9 • Mainstreaming HIV/AIDS 47 Ken
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Voices of Service Users 10 Precious
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Voices of Health Policy Makers and
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• Voices of Health Policy Makers
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Voices of Facility Managers 11 Nata
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11 • Voices of Facility Managers
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Voices of Hospital Superintendents/
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Glossary AIDS Acquired Immune Defic
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• Glossary MEC MINMEC MOU Member
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Index A Abortion (see Termination o
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• Index Condoms .................
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