Thesis (Ph.D.) -- La Trobe University, 2003. Submitted to the School of Public Health, Faculty of Health Sciences. / Includes bibliographical references (leaves 341-378).

Originally presented as the author's Thesis (doctoral)--Universität Bremen, 2005/2006. / Includes bibliographical references (p. 421-460) and index.

Thesis (MBA)--Stellenbosch University, 2004. / ENGLISH ABSTRACT: This study set out to identify the key success factors of Public Private Partnerships (PPPs) in the healthcare sector to be considered by Netcare when exploring possible PPP opportunities. Public Private Partnerships (PPP) presents a means of mobilising private funds for delivering of public services whilst government manages the relationship via a negotiated PPP agreement to ascertain the quality of services rendered. A literature study was performed in order to conceptualize the potential of the application of PPP in the healthcare industry and the factors impacting on the success thereof. PPPs around the world did not develop in unison nor are they uniform in nature. It is this variation in development that led to the formation of a wide variety of different PPP models that define these partnerships. The different PPP models currently applied by Netcare in the UK are similar in their basic characteristics to some of the models described in literature. One of the biggest challenges facing the healthcare industry in South Africa is the unequal split between public and private healthcare sectors. This is not only in terms of number of people serviced but also includes allocation of the available resources. Very limited information is available on application of PPP in the healthcare sector. The private hospital groups primarily involved in PPP in the healthcare industry in SA are Netcare and Medi-Clinic. Netcare has successfully positioned itself not only as the biggest private hospital group in South Africa, but also as the leader in PPP involvement in the healthcare sector in South Africa. The PPP projects undertaken, though still very early days, have been very successful, but do not yield very high returns. The rationale to Netcare for partaking in these extends beyond financial returns. It is mainly strategic in terms of its position in the local market and its potential involvement in the anticipated NHS (National Health System). It is essential that Netcare maintains credibility and goodwill and continues to demonstrate its commitment to address the healthcare industry needs of all in SA. Responding to the limited growth opportunities presented by the local market, Netcare expanded its operations to include international contracts, in particular in the UK, with negotiations under way for contracts in Portugal. The experienced gained through the PPPs in the UK, the country regarded as the leader in PPPs in the healthcare sector, is invaluable to their future participation in PPPs. Governments all over the world want to improve healthcare service delivery and curb healthcare inflation. This presents opportunities to Netcare that could arguably be in the form of a PPP. The ability to evaluate the key success factors that will impact on these PPPs is therefore of great importance to Netcare. The study showed that the actual process involved in forming a PPP depends on various key factors that impact on the outcome thereof. The role of government is essential and it includes the creation of the infrastructure and the legal environment for PPP, to demonstrating competence in managing PPPs, providing the political support and achieving investor confidence. An extensive list of key success factors was identified, but applying these factors to two possible PPP opportunities revealed their shortcomings. It was concluded that the list of factors cannot be applied as the ultimate checklist to pre-determine the outcome of a PPP. This is because various factors will only be revealed in the later stages of the PPP project life. It was also concluded that PPP participation by the company is a priority strategic decision. The strengths and weaknesses of the company relative to the opportunities and threats presented then needs to be evaluated. The list of key success factors provides an important guideline in terms of considering the specific opportunities and threats associated with PPPs. These factors should be considered during the various stages of the project development. / AFRIKAANSE OPSOMMING: Die doelwat van die studie is die identifisering van die faktore wat die sukses van Staat Privaat Vennootskappe (SPV) binne die gesondheidsorg industrie sal bepaal, en wat deur Netcare in ag geneem moet word wanneer sodanige vennootskappe oorweeg word. Hierdie vennootskappe bied 'n geleentheid vir die mobilisering van privaat fondse vir publieke dienslewering terwyl die regering deur middel van die onderhandelde PPP ooreenkoms die verhouding bestuur en die kwaliteit van dienslewering monitor. Die literatuurstudie het ondermeer die potensiaal van sodanige vennootskappe in die gesondheidsorg industrie, sowel as die faktore wat die suksesvolle uitkoms daarvan bepaal, ondersoek. Verskeie SPV modelle en tipes vennootskappe bestaan weens die uiteenlopende ontwikkeling van SPVs in die onderskeie lande. Die modelle tans toegepas deur Netcare in Engeland reflekteer die eienskappe van modelle beskryf in literatuur. Een van die gesondheidsorg indrustrie in Suid Afrika (SA) se grootste uitdagings is die oneweredige verdeling tussen publieke en privaat gesondheidsorg, beide in terme van populasie verteenwoordiging en aanwending van die beskikbare hulpbronne. Inligting aangaande die aanwending van SPV in die gesondheidsorg industrie is baie beperk. In die Suid Afrikaanse konteks is Netcare en Medi-Clinic die dominante rolspelers in SPVs in die industrie. Netcare is tans nie net die grootste privaat hospitaalgroep in SA nie, maar ook die leier op SPV betrokkenheid in die gesondheidsorgsektor in SA. Hoewel die huidige SPV's relatief onlangs tot stand gekom het, is daar reeds heelwat sukses behaal. Die opbrengs gerealiseer is egter nie fenominaal nie. Die motivering vir Netcare se betrokkenheid in hierdie vennootskappe strek egter verder as bloot die finansiële opbrengste. Gegewe die potensiële nasionale gesondheidstelsel en die posisionering in die plaaslike mark, is dit noodsaaklik vir Netcare om gesien te word as toegewyd aan 'n oplossing vir die gesondheidsorg uitdaging in Suid Afrika. Netcare se internasionale uitbreiding kan deels toegeskryf word aan die beperkte groei geleenthede in SA. Hulle internasionale kontrakte sluit in Engeland met onderhandeling in Portugal tans onderweg. Die ondervinding opgedoen met die SPV's in Engeland is van onskatbare waarde gegewe Engeland se posisie as leier op die gebied van SPV in die gesondheidsorg industrie. Verskeie lande poog tans om hulle gesondheidsorg dienslewering te verbeter en mediese inflasie te beperk. Dit skep potensiële SPV geleenthede vir Netcare. Die vermoë om die kritiese sukses faktore wat die uitkoms van hierdie SPVs sal bepaal, te kan evalueer, is dus van kardinale belang vir Netcare. Dit blyk uit die studie dat die proses van die ontwikkeling van SPV deur verskeie faktore beinvloed word. Die regering van 'n land speel 'n belangrike rol in die daarstelling van die infrastruktuur, die regsaspektelike omgewing, hulle bevoegdheid in terme van die bestuur van SPV, hulle vermoë om politiese ondersteuning te verleen en hulle vermoë om beleggers se vertrou te wen. 'n Omvattende lys van faktore wat impakteer op die sukses van SPV is identifiseer. Tydens die toepassing daarvan op twee voorbeelde het dit duidelik geblyk dat die lys nie as allesomvattend beskou kan word en aangewend kan word om vooraf die uitkoms van 'n SPV te voorspel nie. Verskeie faktore wat krities is in die sukses van SPV kan eers bepaal word tydens later stadiums van die SPV. Daar is ook tot die slotsom gekom dat die firma strategie die primêre oorweging tydens die evaluering van SPV behoort te wees. Die sterk en swak punte van die firma relatief tot die geleentheide en bedreigings wat die SPV inhou moet evalueer word. Die lys van faktore krities tot die sukses van SPV dien as 'n belangrike riglyn vir die oorwerging van geleenthede en bedreigings geassosieerd met SPV. Hierdie faktore behoort tydens die verskeie stadia van SPV projek ontwikkeling in ag geneem te word.

published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy

published_or_final_version / Politics and Public Administration / Master / Master of Philosophy

Wits Business School University of Witwatersrand Johannesburg, South Africa Master in Finance and Investment (2014) / Following decades of under-investment, gaps in Africa’s healthcare infrastructure are becoming disturbingly obvious. The interplay of governments’ fiscal policies of budget imbalance reduction and other political considerations present a seemingly insurmountable obstacle to overcoming the backlog in Africa’s healthcare infrastructure. The two main objectives of this study were to understand the sources of financing and the best way to structure the financing of healthcare infrastructure in Africa. Looking at financing arrangements in various industries; and how healthcare sectors in developed countries have been financed, the report draws on perspectives from the financiers on how the healthcare infrastructure gap should be filled in Africa. This study, which utilised survey questionnaires and in-depth interviews, identified government revenues, regional development banks, private equity and donor financing numbers as dominant funding sources for the financing of healthcare infrastructure in Africa. Further, the study explored various ways in which finance could be structured and found that within those various models of financing, donor financing and government revenue were statistically significant on structuring the finance, especially within public-private partnership arrangements. These include sale and lease back arrangements (p=0.0022), complete ownership of projects by the private sector (p=0.003), management operation contracts (p=0.00034) and other forms of PPPs. More perspectives were obtained on enablers and barriers to improving investability of the healthcare sector. Africa’s economic growth and the improving ease of doing business were major enablers for healthcare sector’s investability. However, the role played by government as both a financier and a regulator seemed a barrier. Some structural models that would need government back-up include subordinated debt; with pricing at marginal cost and matching risk and return recovered through the taxation system. The latter continues to characterise much of Africa’s publicly provided healthcare infrastructure. In conclusion, investments in healthcare may not be separated from a country’s level of financial deepening. As the sector develops, it then becomes possible to utilise the models aforementioned. It is recommended that any governments’ investments in healthcare be more catalytic, to unlock value that allows the private sector to compete, both as financiers and innovators in healthcare. Furthermore clear strategies on PPPs are urgently needed for healthcare in Africa including policy consistency in financing and regulating healthcare.

No description available.

Thesis (MPH) --University of Limpopo, 2011 / Since 1994, the post apartheid government and the Department of Health have developed and implemented a number of policies and pieces of legislation that impacted directly and indirectly on the delivery of health services such as the general public health, health personnel, financial matters, transportation of medicines and foodstuffs. These policies were timeously received by the hospitals from National Office, Provincial Departments and Local Government, but were not implemented due to numerous challenges. This study explores the health policy implementation challenges facing implementers in the public health sector in the Capricorn district in Limpopo that constrain them from rendering their managerial functions effectively and thus, impact negatively on policy implementation and service delivery. The objective of the study is to explore the challenges with a view of describing the nature and causes of the challenges, explore and document them, develop suggestions for minimizing these challenges and subsequently suggesting possible solutions. The study focused on the Capricorn district in Limpopo Province. The district is the biggest among the five districts and has eight functional hospitals which are under the leadership of Chief Executive Officers (CEO). The researcher used both qualitative and quantitative (mixed) research methods. The methodology entailed the distribution of self-administered questionnaires containing closed and open ended questions to the management of Capricorn district hospitals. The results obtained in this study revealed that there are numerous challenges that constrain policy implementers from implementing health policies effectively and efficiently in their work environments. These challenges range between poor incentives, lack of equipment, lack of office space, lack of dedicated transport for outreach, budget constraints, shortage of resources – human and physical, lack of career mobility, poor working conditions, communication problems and poor supervision style. These challenges impact negatively on policy implementation.It is therefore recommended that the comprehensive strategy to maximize the health workers’ motivation in the health sector has to involve a mix of financial and non-financial incentives, the provincial department of health and Social Development should open some communication lines with the service providers at grass root level in order to address some of the issues before they become chronic challenges, there should also be regular meetings where feedback about provincial and national issues are addressed to the service providers. The current system of dissemination of information from the province and national government to the hospitals is apparently not clear.

No description available.

No description available.