Prior 1994 South Africa had a fragmented health system designed along racial lines. One system was highly resourced and benefitted the few and the other was under-resourced and was for the black majority. Attempts to deal with these disparities did not fully address the inequities. The objective of the NHI is to address the inequalities by ensuring that all South African have access to affordable, quality healthcare services regardless of their socio-economic status. The majority of the participants do not understand the meaning and the implications of the national health insurance. Among the health professionals that were interviewed, there were no consultations before the implementation of the NHI. The health economists verbalized that it will be too expensive as the majority of citizens do not pay taxes. More roadshows need to be done to make communities aware of the planned strategy which will benefit all. / Health Studies

Submitted in fulfillment of the requirement for the Masters Degree of Technology (Public Relations Management), Department of Public Relations Management, Durban University of Technology, Durban, South Africa, 2015. / In South Africa, the media coverage and the general perceptions of the public about public hospitals have been pervasively negative and this has resulted in the overshadowing of the good work being done in hospitals. In an effort to overcome these negative perceptions, the Kwazulu-Natal Department of Health has introduced the practice of public relations in public hospitals since 2001. This effort is in line with the National Health Act 2004 (Act No 61 of 2003). The act is described by the Health Systems Trust to rest heavily on the Constitution which, amongst other things, requires the State to take reasonable legislative and other measures to progressively achieve the right of access to health care services, and reproductive health care, within its available resources. The rationale behind the introduction of public relations was that, by managing and influencing the public’s perceptions, public relations professionals in public hospitals would initiate a sequence of behaviours that would contribute towards the achievement of the hospitals’ objectives. However, are relevant stakeholders aware of the presence, the role and the functions of public relations in public hospitals? Based on the above, this study seeks to evaluate public relations practices within selected public hospitals in Kwazulu-Natal, South Africa. The study is qualitative, cross-sectional and descriptive in nature. Data will be collected through observation, questionnaires and interviews. The findings revealed that a lot more needs to be done by both the Department of Health in KwaZulu-Natal and hospital CEOs in order to benefit greatly from the practice of public relations in public hospitals as public relations practitioners are under-utilized. Issues of budget constraints, lack of public relations understanding by hospital CEOs are some of the factors impacting negatively the function of public relations in hospitals. It is more of a technical role that public relations practitioners play in public hospitals. This study came to the realisation that not enough attention is given to the practice of public relations in public hospitals. One of the major recommendations is that public relations practitioners should participate in the strategic management processes and be part of the planning process and they should use public relations strategies to build harmony between the hospital and all its external and internal publics. For public hospitals to realise the need and value from the function of public relations, they have to appreciate that the practice of public relations has grown over the years and they have to employ effective public relations practitioners in order to accomplish their goals.

Thesis (MBA (Business Management))--Stellenbosch University, 2008. / ENGLISH ABSTRACT: The aim of this research report was to identify a set of strategic tools that can be transferred from the private health sector to the public health sector, to improve efficiency in the public health sector. To attain to this aim, this research report attempted to identify the selected best practices employed by successful private health providers, to determine the most effective modes to transfer these best practices, and to establish key success factors for the identified best practices. Interviews were conducted with opinion-leaders from the health industry in the Western Cape,and inputs gleaned from these individuals were useful in applying the strategic model to the public and private health sector in the Western Cape. Globally the public sector has already embarked on strategic management initiatives, through the implementation of the New Public Management-model. The introduction of NPM in a few selected countries aimed at achieving cost-efficiency, budget accountability and improved customer focus in service delivery. South Africa however still needs a unifying and all encompassing vision for public and development management to advance the ideals of Batho Pele. The use of evidence and the management of intellectual capital in the health care industry are recognised as important in decision-making. The health care trends of five selected countries (United Kingdom, United States of America, Greece, Canada, Slovakia) were researched , and demonstrated that countries face similar challenges (increasing resource demands, aging population, rapidly expanding technological possibilities, better-informed patients, rising expectations). It is recognised that business skills and knowledge, as well as investments in IT can be effective tools in moving an organisation from a reactive approach to a pro-active approach. Managers in the public sector need different competencies than managers in the private sector due to the differences between the two sectors, and thus there is a need to adapt management training. While there are examples of best practices in the South African government, there is still room for improvement. A stable political economy, political leadership, management skills of political office-bearers and the professionalism of civil servants will be decisive in this regard. The White Paper on the Transformation of the Public Service provides a framework for the development of strategies to promote continuous performance improvements in quantity, quality and equity of health service provision. The areas where improvements are necessary are customer and stakeholder satisfaction, processes, organisation results, leadership and people management. The comparison between the current strategic approach in the Western Cape and a model designed for the public sector revealed that some of the steps can be developed further, namely the assessment of the internal and external environments, the development of an effective implementation process, and the reassessment of the strategies and the strategic planning process. The comparison between the current strategic approach in the Western Cape and the global best practices framework established that there is not sufficient balance between the resource and position based views, the decision-making approach is "quite formal", implementation of strategy is not a carefully planned change management process, planning is regarded as the most important part of the strategic planning process, and evaluating strategy implementation involves more than mere financial measures. It was also established that the Western Cape Department of Health's strategic stance is offensive, that it can be regarded as a prospector, that managing multiple stakeholders is a challenge and that the competitive advantage of the department is its people. The industry analysis revealed that there is still a long way to go in terms of reliable information systems to support health services. The need for a strategic approach that can respond rapidly in a turbulent environment, and the re-look strategic processes to ensure delivery of quality health care through optimal use of resources were also established by the industry analysis. It was established that a gap exists in the public health sector in respect of the strategic planning processes, and that the private health sector portrays characteristics compatible with the global best practices framework. Modes for the successful transfer of best practices were explored, namely management consulting, commercialisation and management development. Two key success factors for the transfer of best practices were identified, namely the application of the Batho Pele principles, and the recruitment and retention of suitably qualified staff. From a global strategic management perspective, it was clear that there is a definite need for the public sector to change to private sector strategic approaches. A shift from a reactive to a pro-active approach is also advisable. The global trends in public health care demonstrate the importance of political leadership, competent management, business knowledge and skills, IT investment and the use of evidence in health. It is clear that the provision of public health care in South Africa faces similar challenges to those experienced by the five countries researched. The application of the global best practices framework confirmed that there are in fact best practices employed by the private sector that can be transferred to the public sector. Most of the best practices discussed in this research report are not employed in the public sector, or only on a limited scale. The use of these practices should be explored by the public sector. In order to equip managers in the public sector with the necessary strategic management tools, training and development opportunities must include modules on strategic management. / AFRIKAANSE OPSOMMING: Die doel van hierdie navorsingsverslag was om 'n stel strategiese benaderings te identifiseer wat van die privaat-gesondheidsektor na die openbare gesondheidsektor oorgedra kan word, om effektiwiteit in die publieke gesondheidsektor te verbeter. Ten einde hierdie doel te bereik, was daar gepoog om geselekteerde beste praktyke wat deur die privaat gesondheidsektor gebruik word te identifiseer, om te bepaal wat die mees effektiewe metodes sou wees om dit oor te dra, en om kritiese suksesfaktore vir die bepaalde beste praktyke te identifiseer. Onderhoude is gevoer met prominente leiers in die gesondheids-industrie in die Wes-Kaap, en hierdie insette was waardevol in die toepassing van die strategiese model op die publieke en privaat-gesondheidsektor in die Wes-Kaap. Op die internasionale front het die publieke sektor reeds strategiese bestuurs-inisiatiewe begin toepas, deur die implementering van die NPM-model. Die implementering van NPM in 'n paar geselekteerde lande was gemik op koste-effektiwiteit, begrotingsverantwoordbaarheid en verbeterde fokus op kliente in dienslewering. Suid Afrika het egter steeds die behoefte aan 'n oorkoepelende, verenigende visie vir publieke- en bestuursontwikkeling om uitvoering te gee aan die ideale van Batho Pele. Die gebruik van uitkomste en die bestuur van intellektuele kapitaal in die gesondheidsindustrie word erken as belangrik vir besluitneming. Die neigings in gesondheidsorg van vyf gekose lande (Verenigde Koninkryke, Verenigde State van Amerika, Griekeland, Kanada en Siovakye) toon dat die uitdagings vir gesondheid ooreenstem (verhoogde vraag na hulpbronne, verouderende bevolking, vinnige ontwikkeling van tegnologie, beter ingeligte pasiente, hoër verwagtinge). Dit word aanvaar dat besigheidsvaardighede en -kennis, sowel as beleggings in inligtingstegnologie effektief aangewend kan word om 'n organisasie van 'n reaktiewe tot 'n pro-aktiewe benadering te beweeg. Bestuurders in die publieke sektor benodig vaardighede wat verskil van bestuurders in die privaatsektor weens verskille tussen die twee sektore; daar is dus 'n behoefte om bestuursopleiding aan te pas. Daar is wel voorbeelde van beste praktyke in die Suid-Afrikaanse regering, maar daar is steeds ruimte vir verbetering. 'n Stabiele politieke ekonomie, politieke leierskap, bestuursvaardighede van politieke ampsdraers en die professionaliteit van staatsamptenare sal deurslaggewend wees in hierdie verband. Die Wit Skrif oor Transformasie van die Openbare Sektor verskaf 'n raamwerk vir die ontwikkeling van strategiee om voortgesette verbeteringe in hoeveelheid, kwaliteit, en gelykheid in die voorsiening van gesondheidsorg te bevorder. Areas vir verbetering sluit in kliente en belanghebbende tevredenheid, prosesse, organisatoriese uitslae, leierskap en bestuur van mense. Die vergelyking van die huidige strategiese benadering in die Wes-Kaap met 'n model wat ontwikkel is vir die publieke sektor toon dat sommige van die stappe verder ontwikkel kan word, naamlik die evaluering van die interne en eksterne omgewing, die ontwikkeling van effektiewe implementeringsprosesse, en die herevaluering van die strategiee en die strategiese beplanningsprooes. Die vergelyking van die huidige strategiese benadering in die Wes-Kaap met die globale beste praktyke raamwerk toon dat daar nie genoeg balans is tussen die posisie- en hulpbrongebaseerde stand nie, dat besluitneming "nogal formeel" is, dat implementering van strategie nie 'n sorgvuldig beplande veranderingsbestuursproses is nie, en dat evaluering van implementering meer behels as slegs finansiele maatstawwe. Dit het ook aan die lig gekom dat die Wes-Kaap departement van gesondheid 'n offensiewe stand het, dat dit as 'n prospektor beskou kan word, en dat die bestuur van veelvuldige belangehebbendes 'n uitdaging is. Die analise van die industrie het getoon dat daar nog baie gedoen kan word in terme van betroubare inligtingstelsels om gesondheidsdienste te ondersteun. Die behoefte aan 'n strategiese benadering om vinnig te reageer in 'n turbulente omgewing, en die her-evaluering van strategiese prosesse om die lewering van kwaliteit gesondheidsdienste deur die optimale gebruik van hulpbronne te verseker, is ook bevind in die analise. Daar is ook bevind dat daar 'n gaping in die publieke gesondheidsektor is wat die strategiese beplanningsproses betref, en dat die privaat-gesondheidsektor kenmerke openbaar wat verenigbaar is met die globale beste praktyke raamwerk. Metodes vir die suksesvolle oordrag van beste praktyke, naamlik bestuurskonsultasie, kommersialisasie en bestuursontwikkeling word beskryf. Twee sleutelsuksesfaktore vir die oordrag van beste praktyke, naamlik die toepassing van die Batho Pele beginsels, en die werwing en behoud van toepaslik gekwalifiseerde personeel is identifiseer. Uit 'n globale strategiese bestuursperspektief was dit duidelik dat daar definitief 'n behoefte is vir die publieke sektor om privaatsektor strategiese benaderings aan te neem. 'n Beweging van 'n reaktiewe tot 'n pro-aktiewe benadering is beslis aan te beveel. Die globale neigings in publieke gesondheidsorg demonstreer die belangrikheid van politieke leierskap, bevoegde bestuur, besigheidskennis en -vaardighede, beleggings in inligtingstegnologie en die gebruik van uitkoms-gebaseerde bewyse. Dit is duidelik dat die voorsiening van publieke gesondheidsorg in Suid-Afrika ooreenstemmende uitdagings het met die vyf lande wat ondersoek is. Die toepassing van die globale beste praktyke raamwerk het bevestig dat daar wel beste praktyke gebruik word deur die privaatsektor, wat oorgedra kan word na die publieke sektor. Meeste van die beste praktyke hier bespreek word nie deur die publieke sektor gebruik nie, of slegs op 'n beperkte basis. Die gebruik van hierdie praktyke moet ondersoek word deur die publieke sektor. Om bestuurders in die publieke sektor toe te rus met die nodige strategiese bestuursvaardighede, moet opleidings- en ontwikkelingsgeleenthede modules insluit oor strategiese bestuur.

The aim of this thesis was to conduct a situational assessment of human resources planning at one local health authority, in order to determine how decentralisation has impacted the effectiveness of human resources planning.

The research explored the new health care service vehicle of South African with special reference to health service providers in Western Cape Department of health for the period 1995-2001. A study was made of the District Health System and the shift of emphasis from tertiary and secondary level of health care to the more cost effective Primary Health Care Service rendered at District level.

This descriptive case study of the transformation in medical care at the community level was carried out with a triangulation approach. Data from documents and surveys using both semi-structured and unstructured interviews were gathered to evaluate and explain how medical care delivery changed from a primarily public system to one predominantly private.

INTRODUÇÃO: A atuação de uma equipe de reabilitação junto à Estratégia Saúde da Família (PSF), iniciada na cidade de São Paulo no ano de 2001, inaugura um serviço singular de atenção a pessoas com deficiência na atenção básica. Tal projeto tem como objetivo estabelecer uma cultura de defesa dos direitos da pessoa com deficiência na busca do desmonte dos processos de exclusão social, construindo intervenções que articulem a prevenção de deficiências, reabilitação e educação por meio de ações intersetoriais (Fichino et al, 2008). Essa pesquisa visa conhecer e analisar aspectos da organização do trabalho desse serviço, à luz de aspectos do referencial teórico da gestão da operação de serviços. MÉTODO: Pesquisa qualitativa do tipo estudo de caso baseada nos princípios de Yin (2003) que combinou diferentes procedimentos de coleta de dados (pesquisa documental, entrevistas semi-estruturadas e aplicação de questionários). Foram realizadas sete entrevistas com trabalhadores de uma equipe de reabilitação no ano de 2007. Cada fonte de evidência recebeu tratamento diferenciado tendo em vista a finalidade de sua utilização e posteriormente foi realizado um diálogo dos resultados obtidos para construção de uma cadeia de evidências sobre a qual se construiu o estudo do caso. RESULTADOS: Foi verificado nesse estudo que o conceito do serviço pesquisado não se consolidou devido às mudanças nas políticas públicas de saúde que ancoravam essa experiência e a falhas no projeto do serviço, como por exemplo, o não detalhamento da organização do trabalho. Isso teve impacto para os trabalhadores que diante da fluidificação do conceito do serviço passam a organizar suas ações a partir de estratégias individuais ou de demandas pontuais se remetendo pouco aos pressupostos que fundamentam o serviço. Para os gestores tal quadro resulta na dificuldade de alinhar suas expectativas com o serviço realizado de fato. CONCLUSÃO: O hiato que existe entre a operação e o conceito precisa ser preenchido em duas vias: uma aproximando as proposições teóricas presentes no conceito do serviço da realidade cotidiana de quem desempenha o trabalho; e, na direção oposta, reforçando as premissas do projeto pelo refinamento e incorporação dessas pelos profissionais de linha de frente e gestores / The performance of a rehabilitation team together with the Family Health Program (FHP), begun in the city of São Paulo in 2001, launches a unique service to attend people with deficiencies in primary care. Such service aims to establish a consciousness of protection of the rights of disabled people in order to dismantle the process of social exclusion by creating actions to promote the prevention of disabilities as well as education and rehabilitation through intersectorial interventions. This research seeks to understand and analyze aspects of the work organization of this rehabilitation team based on the theoretical framework of the service operation management. METHODS: Qualitative research conducted by means of case study following Yins principles (2003) which combined different procedures for data collection (desk research, semistructured interviews and questionnaires). Seven interviews were conducted with employees of a team of rehabilitation in 2007. Each source of evidence received a differentiated treatment according to the purpose of its use. And, later, the results obtained were compared for the construction of a chain of evidences on which a case study was built. RESULTS: It has been verified in this study that the concept of the service was not consolidated due to: 1. changes in public health policies that anchored this experience; 2. flaws in the project of the service, such as, the lack of detailing the work organization. These results had an impact on the workers who, before the weakening of the concept of the service, began to base their actions on individual strategies or specific demands, referring very little to the directives that ground the service. For the managers such situation is result of a difficulty to align their expectation with the actual service. CONCLUSION: The gap that exists between the operation and the concept needs to be completed in a two-way street. One way, approaching the theoretical propositions in the concept of the service from the daily reality of who performs the work. And, on the other way, reinforcing the premises of the project by the refinement and incorporation of the front-line professionals and managers

A presente dissertação é resultado de uma pesquisa de mestrado realizada acerca dos temas controle social e Política de Saúde do Trabalhador e da Trabalhadora na atenção básica. A partir de diversas conceitualizações, este trabalho opta pela definição de que o controle social está a serviço de um Estado democrático de acesso igualitário a direitos e de participação da população no planejamento e acompanhamento de todas as ações deste mesmo Estado. A Política de Saúde do Trabalhador tem origem no período brasileiro de lutas democráticas contrárias ao autoritarismo do governo militar e em consonância com a perspectiva da Saúde Coletiva, que considera o contexto econômico, financeiro e social de organização dos processos de trabalho. Esta pesquisa delineou-se como um estudo de caso de análise situacional, cuja questão norteadora e objetivos foram construídos após realização de pesquisa exploratória em um Conselho Gestor de um Centro de Referência em Saúde do Trabalhador do Rio Grande do Sul. O campo foi escolhido em consonância com as pesquisas previamente realizadas pelo Núcleo de Estudos e Pesquisa em Saúde e Trabalho (NEST) da Universidade Federal do Rio Grande do Sul. O objetivo principal proposto foi identificar como se dá a participação do Conselho Gestor na implementação da Política Nacional de Saúde dos Trabalhadores e das Trabalhadoras junto ao Centro de Referência em Saúde do Trabalhador. As técnicas utilizadas foram realização de grupo focal, com apoio de um roteiro de entrevista semiestruturada, diário de campo e revisão teórica e documental acerca do tema. Para análise dos dados foi utilizado o método de análise de conteúdo. A sistematização das categorias foi realizada a partir dos objetivos. Os resultados encontrados são referentes ao Conselho Gestor ser uma instância sobre a qual os conselheiros tem pouca clareza do seu lugar; os conselheiros entendem que devem estimular e realizar práticas relativas a atenção básica de prevenção e promoção da saúde do trabalhador; a relação estabelecida com os gestores públicos acontece com diversas dificuldades; os próprios conselheiros tem dificuldade de se ver na posição de gestores e por fim, apontam diversas práticas democráticas de gerenciamento que desempenham sem perceber que estão realizando gestão. Nas considerações finais fica evidenciado o mérito da organização coletiva e democrática deste grupo de Conselho Gestor, o qual não tem diretriz nacional específica a seguir, portanto organizando-se desta forma espontaneamente. / The present dissertation is the result from a master’s degree study performed on social control themes and the Health Policy of the male and female Workers in basic care. It is based on diverse conceptualizations; this study opted for the definition that social control is the work of a democratic State for egalitarian access to rights and the participation of the population in the planning and following up on all the actions of that same State. The Worker Health Care Policy originated in the Brazilian period of democratic struggles against the authoritarianism of the military government and in consonance to the perspective of Collective Health Care, which considers the economic, financial, and social context of the organization of labor processes. This research study was delineated as a situational analysis case study, whose guiding theme and objectives were constructed after performing exploratory research on an Administrative Council of a Reference Center in a Worker Health Care Center in the state of Rio Grande do Sul. The field was selected in consonance with the previous research studies performed by the “Núcleo de Estudos e Pesquisa em Saúde e Trabalho” (NEST) (Health and Labor Research and Study Nucleus) of the “Universidade Federal do Rio Grande do Sul” (Federal University of Rio Grande do Sul). The main proposed objective was to identify what the participation of the Administrative Council is like in the implementation of the National Health Policy of Male and Female Workers at the Reference Worker Health Care Center. The techniques used were performed on the focal group, supported by a semi-structured outline, field diary, and theoretical and documental revision on the theme. The content analysis method was used for data assessment. The systematization of the categories was performed based on the objectives. The result findings refer to the Administrative Council as being an entity by which the counselors perform their role unclearly; the counselors understand that they must foment and perform practices related to basic preventive care and promote the health of workers; the relationship established with the public administrators takes place facing diverse hindrances; the respective councilors find it difficult to place themselves in the position of administrators and ultimately that point out diverse democratic practices of management achieving results without realizing that they are administrating. In the final considerations the merit of the collective and democratic organization became evident of this group of the Administrative Council, which does not have a specific national guideline to follow; therefore it is organized in this spontaneous format.

Prior 1994 South Africa had a fragmented health system designed along racial lines. One system was highly resourced and benefitted the few and the other was under-resourced and was for the black majority. Attempts to deal with these disparities did not fully address the inequities. The objective of the NHI is to address the inequalities by ensuring that all South African have access to affordable, quality healthcare services regardless of their socio-economic status. The majority of the participants do not understand the meaning and the implications of the national health insurance. Among the health professionals that were interviewed, there were no consultations before the implementation of the NHI. The health economists verbalized that it will be too expensive as the majority of citizens do not pay taxes. More roadshows need to be done to make communities aware of the planned strategy which will benefit all. / Health Studies

Neste trabalho foram identificados os conceitos de regulação em saúde empregados na literatura científica nacional sobre gestão em saúde. Foi elaborada uma tipologia para o conceito de regulação utilizando os conceitos de regulação de outras disciplinas (ciências da via, direito, economia, sociologia e ciência política). Essa tipologia baseou-se no agrupamento das ideias que fundamentam a concepção da regulação naquelas disciplinas. Das diferen-tes ideias relacionadas ao emprego dos conceitos de regulação, destaca-ram-se quatro como fundamentais, quais sejam: controle, equilíbrio, adaptação e direção. A partir dessa tipologia, os conceitos de regulação identificados nos artigos científicos nacionais foram classificados e analisados. Considera-se que a discussão do conceito de regulação em saúde está relacio-nada com a compreensão da inserção do Estado no setor saúde, ou seja, o papel que o Estado exerce nesse setor. Os conceitos de regulação em saúde apresentam uma variedade de significados, abordagens e finalidades. O tema da regulação em saúde está conexo ao da reforma política e administrativa do Estado. No entanto, o que diferencia esses conceitos de regulação é justamente a definição de diferentes formas de intervenção do Estado. Por fim, destaca-se o maior peso para a natureza técnica da regulação (gerencial) dos conceitos de regulação em saúde apresentados nos artigos objeto deste estudo. A natureza política da regulação ficou em segundo plano / The purpose of this study was to identify the concepts of health regulation employed in the national scientific literature on healthcare management. The study developed a typology for the concept of regulation using the concepts of regulation from other disciplines (Life science, Law, Economics, Sociology and Political science). This typology was based on the grouping of the ideas underlying the design of regulation in those disciplines. Considering the various ideas related to the use of the concepts of regulation, four were considered as fundamental ideas, namely: control, balance, adaptation and direction. From this typology, the concepts of regulation found in the national papers were classified and analyzed. It is considered that discussion of the concept of health regulation is related to the understanding of the integration of State in the health sector, namely the role that the State has in this sector. The concepts of health regulation offer a variety of meanings, approaches and goals. The theme of health regulation is related to the political and administrative reform of the state. However, what differentiates these concepts of regulation is precisely the definition of different forms of State intervention. Finally, it was highlighted the emphasis to the more technical nature of regulation (management) concepts of health regulation presented in the articles analyzed. The political nature of regulation was in the background