The 2019 NHI district pilot evaluation report was circulated somewhat belatedly last week to Parliament as an addendum to Health Minister Zweli Mkhize’s written reply to questions from the Democratic Alliance’s Hassina Ismael, writes Pam Saxby for Legalbrief Policy Watch.
“While concerns about the report’s implications for NHI implementation have been the subject of widespread media speculation since it was released, commentators appear to have overlooked the issue of ‘organisational culture’. Neither has the Minister commented on the matter, despite the report’s numerous references to shortcomings identified in the health care facilities evaluated. At the time, they were found to limit problem-solving and innovation – leaving ordinary staff members feeling disempowered, undervalued and demotivated,” writes Saxby
During a question and answer session in Parliament last September, Mkhize nevertheless insisted that NHI will be ‘successful’.
According to the report, during the evaluation it became apparent that ‘certain stakeholders are fearful of raising issues within current governance structures and of questioning the status quo’. ‘This stifles the generation of useful evidence, limits learning and diminishes the opportunity to benefit from the … experiences and ideas of … people that work within the system’, the report noted. Drawing attention to the importance of creative, responsive staff members licensed to ‘take the initiative’ when ‘embarking on a comprehensive health system strengthening and reorganisation programme’, it recommended that ‘leadership styles’ be assessed and ‘mentorship’ made widely available at management level.
The potential for a stifling organisational culture to compound other problems identified during the evaluation is obvious. A Business Day article published when the report was released refers, among other things, to inadequate staff levels and infrastructure; poor Internet connectivity (affecting the patient registration system and, presumably, the capacity to monitor medicine stock levels); learner health status screening and related interventions; access to health care for pregnant mothers and infants; primary health care community outreach initiatives; and input from private sector general practitioners and specialist doctors. Creating an environment in which staff are encouraged to use their initiative and respond innovatively when challenges arise is fundamental to addressing these issues.
It remains to be seen if the National Assembly’s health committee will have the latitude to discuss them this year as it proceeds with the processing the NHI Bill, which focuses on establishing the necessary fund and providing for its governance. Meanwhile, Saxby writes, the Health Department is confident that – as a Public Finance Management Act section 3(A) entity – the NHI fund will be run with the same levels of efficiency and integrity apparently demonstrated by “more than 150” similarly constituted national public entities and “hundreds more in the provincial sphere”. Unfortunately, two of South Africa’s largest national section 3(A) institutions tend to make nonsense of the department’s claim: the Road Accident Fund and National Student Financial Aid Scheme, each of which is notorious for mismanagement.Legalbrief Policy Watch material Pilot Evaluation Report Full Business Day report
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