sector skills plan for the health sector in south africa

3.8 MANAGEMENT OF THE HEALTH SYSTEM
Challenges to the health system exist at managerial and governance levels, and operational levels as
well. The DBSA highlights widespread inefficiencies that result in services that are unresponsive to
health and patient needs and a lack of accountability on a large scale. 95
A decade ago the DoH’s Human Resources for Health Strategy identified skills needs in the areas of
management of health systems, organisational development, as well as education and training. Many of
these challenges persist. A health sector audit in 2009 commissioned by the Minister of Health
documented significant inefficiencies in the management of the public health system. Local managerial
capacity of and decision-making by professionals were found to be compromised by centralised
decision-making at national and provincial levels. This compromises accountability for patient care.
Valuable skills (i.e. “institutional memory”) were lost due to a combination of voluntary severance of
skills in the mid 1990s and simultaneous recruitment of inexperienced managers as replacements.
Observers are concerned that middle- and senior-level posts continue to be filled by insufficiently
qualified people who jobhop to the next opportunity without transferring skills. 96
Some of the management challenges include the lack of: efficient and effective human resources
management; training, support and supervision; and performance management. Complaints of
absenteeism, moonlighting, poor discipline and incompetence are frequent. 97
Greater accountability is needed at all levels. Managers require skills in the management of time and
resources, in planning, in performance management and financial management, in procurement of
supplies, and in leadership and innovation. 98 A particular need for planning and management skills
exists at district level in the public health sector. Research has shown that the skills of middle- and
senior management in the district health system remain weak, despite intensive training interventions.
It has been suggested that a need exists for more comprehensive and nationally standardised training
for primary healthcare and for the development of district health systems. 99
95 Development Bank of South Africa. 2008. A Roadmap for the Reform of the South African Health System.
96 Coovadia, H., Jewkes, R., Barron, P. et al. 2009. “The health and health system of South Africa: historical roots of current
public health challenges”. Lancet. September 2009. Vol. 374. Published at http://thelancet.com. (Accessed August 2010);
Development Bank of South Africa. 2008. A Roadmap for the Reform of the South African Health System.
97 Coovadia, H., Jewkes, R., Barron, P. et al. 2009. “The health and health system of South Africa: historical roots of current
public health challenges”. Lancet. September 2009. Vol. 374. Published at http://thelancet.com. (Accessed August 2010).
98 National Treasury. 2009. “Health”. In Provincial Budgets and Expenditure Review 2005/06 – 2011/12; Harrison, D. 2009. An
Overview of Health and Health care in South Africa 1994-2010: Priorities, Progress and Prospects for New Gains. Published at
www.doh.gov.za (Accessed February 2010); Coovadia, H., Jewkes, R., Barron, P. et al. 2009. “The health and health system of
South Africa: historical roots of current public health challenges”. Lancet. September 2009. Vol. 374. Published at
http://thelancet.com. (Accessed August 2010); Karim, S.S.A, Churchyard, G. J., Karim, Q. A. et al. 2009. “HIV infection and
tuberculosis in South Africa: an urgent need to escalate the public health response”. Lancet. September 2009. Vol. 374.
Published at http://thelancet.com. (Accessed August 2010).
99 Lehmann, U. 2008. “Strengthening Human Resources for Primary Health Care” South African Health Review. Health Systems
Trust. Published at www.hst.org.za/publications/841. (Accessed August 2010).
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