Thesis (MPA)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: The goal of this research was to investigate effective leadership that drives organisational change in the public health sector to meet the changing environmental needs to improve service delivery within the Western Cape Department of Health. Organisational change in the public health sector must lead to improved public health service delivery. The role of leadership is to deal with incompetent personnel as they are the cause of problems regarding inadequate service delivery. Leadership must contribute to the main areas where competency development needs to take place. Healthcare 2030 requires transformational leadership from the ranks of managers and clinicians for collective and distributed leadership across all levels of organisations. The research methodology used in this study was a combination of qualitative and quantitative research methodologies. The methodology included an empirical investigation in the form of a literature review and a preliminary semi-structured interview as well as a nonempirical investigation. The empirical investigation was conducted by using semi-structured interviews as well as a survey questionnaire which was designed to gather information focussing on leader personality traits, task-related traits and understanding the organisation. This study specifically focussed on effective public leadership to drive organisational change in the health sector and to improve service delivery. The results provide support for a cohesive trait-behavioural model of leadership effectiveness. In general, leadership traits associated with task competence are related to task-oriented leadership behaviours, which improve performance-related leadership outcomes. Effective leadership in the public health sector that drives organisational change is based on the general personality traits of a leader, task-related traits and understanding the organisation. These are the elements that are important for effective public leadership to improve service delivery. / AFRIKAANSE OPSOMMING: Die doel van hierdie navorsing was om doeltreffende leierskap, wat organisatoriese verandering in die openbare gesondheidsektor teweeg kan bring, te ondersoek. Sodoende kan in die veranderende omgewingsbehoeftes voorsien word en kan die Wes-Kaapse Department van Gesondheid verbeter. Organisatoriese verandering in die openbare gesondheidsektor moet tot verbeterde openbare gesondheidsdienslewering lei. Die rol van leierskap is om onbekwame personeel te hanteer omdat hulle die oorsaak van probleme met betrekking tot onvoldoende dienslewering is. Leierskap speel ‘n sleutelrol in die bevordering van bevoegdheidsontwikkeling. Healthcare 2030 vereis transformerende leierskap uit die geledere van bestuurders en dokters oor alle vlakke van organisasies heen. Die navorsingsmetodologie wat in hierdie studie gebruik is, was ’n kombinasie van kwalitatiewe en kwantitatiewe navorsingsmetodologieë. Die metodologie het ’n empiriese ondersoek in die vorm van ’n literatuuroorsig en ’n voorafgaande semi-gestruktureerde onderhoud asook ’n nie-empiriese ondersoek, ingesluit. Die empiriese ondersoek is uitgevoer deur van semi-gestruktureerde onderhoude en ’n opnamevraelys gebruik te maak. Die vraelys is ontwerp om inligting met betrekking tot leiers se persoonlikheidseienskappe, taakverwante eienskappe en ’n begrip van die organisasie te ondersoek. Hierdie studie het spesifiek op doeltreffende openbare leierskap gefokus om organisatoriese verandering in die gesondheidsektor te bewerkstellig en dienslewering te verbeter. Die resultate ondersteun ’n samehangende eienskapgedragmodel van leierskapdoeltreffendheid. Oor die algemeen is leierskapeienskappe wat met taakbevoegdheid geassosieer word, verwant aan taakgeöriënteerde leierskapgedrag wat prestasieverwante leierskapuitkomste verbeter. Doeltreffende leierskap in die openbare gesondheidsektor wat organisatoriese verandering dryf, is gegrond op die algemene persoonlikheidseienskappe van ’n leier, taakverwante eienskappe en ’n begrip van die organisasie. Dit is die elemente wat belangrik is vir doeltreffende openbare leierskap om dienslewering te verbeter.

M.Comm. / Health care in South Africa has been well described in terms of structure. However, to what extent would it be possible to describe the health care sector in South Africa in terms of that used to describe an industry? What conclusions could be drawn at the end of the study if this was or was not possible? Strong emphasis in industry analysis is placed on the nature of the competitive forces and on levels of profitability. Can the South African health care sector also be described in those terms? The following objectives can be identified in this study: To complete a literature review on the structure of health care in South Africa in terms of facilities, geographic location, services offered, manpower, financing, remuneration, population served and legislation. To complete a literature review on models and methods that can be used to analyse industries. To determine to what extent it is possible to apply Porter's model (and others) of industry analysis to the South African health care industry. To identify key success factors for the industry. To draw conclusions from the study and make some recommendations.

The South African Health Care environment is in state of reform. Government strategy and change in legislation have been the catalyst for the development of new business models in South Africa. This report deals with the feasibility of a proposed model which is to be implemented by the Eastern Cape Department of Health at the Provincial Hospital in Uitenhage. The fundamental challenge in South Africa is the shortage of resources to support the health care industry from a public perspective. The point of departure for this research was to understand the complexity of this industry and investigate models that have evolved in South Africa and internationally. The literature research covers funding mechanisms from both a public and private perspective and takes into account the role the government plays in providing equitable health care for all. The literature provided the foundation to develop the model which is to be piloted at the hospital in Uitenhage. In terms of the research objective, a single case study methodology approach was conducted. Triangulation technique was used to gain insight from different perspectives and to test the model for validity. The core of this research focuses on the viability of the proposed model and the integration of this into the government health reform plan. The research revealed that in comparison to the existing PPP models in South Africa, this model is feasible. As a result of the analysis and the development of the proposed model, the research is concluded by offering suggestions for further research.

It was perceived that an imbalance exists between resource allocations for health care within the Ekurhuleni Health District (EHD). This study consequently used a retrospective, quantitative methodology to investigate health equity in the EHD and to collect information on clinic buildings, staffing and budget allocations. Although clinics were oversupplied in terms of the norms set by the National Department of Health, they were found not to be in keeping with population growth in the Ekurhuleni district. The study highlighted an inequitable spread of nursing staff, which would require that nursing personnel be re-deployed. The per capita spending in the different service delivery regions was also found to be inequitable. It was subsequently recommended that spending on clinics be revised (especially in the populous Southern SDR), that staff be reallocated and that budget allocations be reviewed to achieve equity in Ekurhuleni. / Health Studies / Thesis (M.A. (Public Health))

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.

<p>This study aimed to contribute to the current debate around equity in health care resource allocation by measuring the current allocation of resources, relative to need in the Northern Cape. It also discussed the level of inequities in health financing/expenditure and staffing at the primary health care level between different districts of the Northern Cape.</p>

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 development of health systems in sub-Saharan Africa has been seriously challenged in the last two decades by the rise of HIV/AIDS. In this thesis I argue that the interface between health policy and HIV/AIDS in South Africa is poorly understood and that this has been to the detriment of fairly radical health care reforms as well as more general health systems development. The research problem outlined above is two-fold, requiring different types of enquiry and analysis. Firstly, there is a gap in our understanding of the impact of HIV/AIDS on health systems. Empirical evidence is presented from research on health facilities and health management structures in Ugu district, KwaZulu-Natal to address this concern. Secondly, it is asserted that our limited understanding of the impact of HIV/AIDS and the nature of the epidemic have prevented a true appreciation of its significance for health policy. This dimension of the problem is addressed through an analysis of South African health policy from 1994 through to the present, as well as a more theoretical look at the potential future influence of the antiretroviral therapy programme on the health system. Both quantitative and qualitative methodologies are employed in this research to acquire empirical insights. Health service utilisation trends are assessed retrospectively by quantitative analysis of key indicators from district and provincial information systems. Meanwhile, the prospective component of the quantitative research can best be described as repeat cross-sectional surveys of a selection of health facilities in Ugu district. These surveys capture data on the profile of patients seeking care and the resource requirements for managing these patients. Qualitative methodologies (predominantly semi-structured interviews) are used at facility level to gain insight into human resource issues and at the management level to better understand health system functioning in relation to HIV/AIDS. One would expect the increasing HIV prevalence and burden of AIDS illness in South Africa to translate into a higher demand for health care. However, this has not occurred in Ugu district, largely because of difficulties with access to care. Despite this, at lower level health services, namely clinics and district hospitals, HIV-related service provision has outpaced an increase in resources. Specifically, the introduction of the antiretroviral therapy programme and the decentralisation of a range of HIV/AIDS services are causing new strains on the system. In essence, the epidemic has created a need to address barriers to accessing care and to expand support for district health services. HIV/AIDS not only increases the demand for health care, but on the supply side erodes the capacity of the health system to deliver care. My research demonstrates that health care workers in KwaZulu-Natal are being severely impacted by the epidemic, with the nature of their work contributing to both their susceptibly and vulnerability. Not only is HIV/AIDS increasing absenteeism and attrition through escalating morbidity and mortality, but it is also working in more subtle ways to contribute to a range of 'push' factors driving health workers from the public health sector. None of these issues have been addressed because of the narrow definition of 'human resource management', despite the obviously heightened need to monitor attrition trends and develop creative retention strategies. My research looks not only at the impact of HIV/AIDS impact on health services in Ugu district, but also at the impact of the epidemic on higher levels of the health system which constitute management structures. At these levels, the health system is challenged by an urgency to deliver HIV/AIDS services, as well as an increasing involvement of donors and partners such as civil society organisations or faith based organisations. This has resulted in trends towards more centralised control of planning and management and, in some instances, a deflection of resources towards HIV/AIDS issues and programmes. This context has called for a strong focus on capacity development and means to ensure the integration of health programmes. Many of the trends in Ugu district demonstrate the insidious nature of HIV/AIDS impact and give some insight into why these trends have not been adequately addressed by South African health policies. My analysis suggests that despite the appropriateness of the overarching direction of health reforms, some concerns arising from the HIV/AIDS epidemic have received little attention. These include a need to: 1) manage human resource impacts, 2) develop home community based care and establish a continuum of care, and 3) lead and direct the involvement of donors and partners in the health sector. On the other hand, there have been some beneficial policy developments, such as the elimination of user fees for certain services and the attention paid to the way in which a focus on HIV/AIDS care can potentially weaken the health system. Unfortunately, in many instances HIV/AIDS has also widened the gap between policy and implementation and opportunities have been missed to develop the health system in an appropriate manner. The South African antiretroviral therapy programme, launched in 2003, is a source of uncertainty regarding the future development of health policy in the country. My analysis makes use of scenarios to explore the potential future impact of the programme. I consider the ways in which the programme is steering us away from our post-apartheid vision of an equitable and well functioning national health system and towards 'AIDS exceptionalism'. I look to Botswana, the first country in southern Africa to provide antiretroviral therapy in the public health sector, for early lessons as to what we might expect. My case study of this programme suggests that HIV/AIDS care can be integrated with time, so limiting damage to the development of fragile health systems. Only through ongoing reassessment of the South African situation will it become apparent whether such lessons are transferable. Nonetheless, forward thinking should allow us to move from a crisis-orientated response to one that is more strategic. This thesis concludes with four key messages (or recommendations) emerging from both the empirical research and the health policy analysis. Firstly, there is a clear need to establish systems that can provide comprehensive and timely information concerning the impact of HIV/AIDS on public health services. Secondly, trusting relationships have to be built between academics/researchers and health policy makers so that research informs policy. Thirdly, there is a need to (re)establish a shared vision of the national health system and maintain a focus on achieving this vision. Finally, priority programmes and resources allocated to these must be used to strengthen our national health system in creative ways. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2007.

<p>This study aimed to contribute to the current debate around equity in health care resource allocation by measuring the current allocation of resources, relative to need in the Northern Cape. It also discussed the level of inequities in health financing/expenditure and staffing at the primary health care level between different districts of the Northern Cape.</p>

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.