Crucial changes in time for NHI
During his state-of the-nation address earlier this year, President Jacob Zuma said the country’s hospitals need to be run by appropriately qualified managers in order to improve the quality of the health service. This week, Health Minister Dr Aaron Motsoaledi, admitted that the leadership of the country’s hospitals is partly responsible for the bad state of hospital services. To remedy the problem, the Health Minister said that the current model, which requires that hospitals be run like businesses has to go.
“I certainly don’t affiliate to that type of thinking. Hospitals are not business entities. They are social entities”, Motsoaledi said.
“For that reason, the manner in which they are managed and the manner in which you arrange for their management, you look at: How do I successfully, efficiently and effectively provide social services, not how do I run a business because when you think about running a business, it has got different ethics altogether. Perhaps that is what put us in this problem where we are. What if the person at Level 8 is the best business person? But do they understand anything about how a hospital runs?” , he continued.
Motsoaledi raised concern that some of the country’s hospitals are managed by low level employees, who, according to ranking in the public service, fall under Level 8, which is a junior level of someone who does clerical work. The current model of hospital management recognises that a person of that level can have the acumen of running a business. However, although they may understand how a business should run, they don’t have a background in health and this often compromises the quality of clinical services hospitals are able to render to patients.
“How can a person at the level of clerical be the head? And the complex situation that we have is that, as you know, the hospitals are managed by a CEO, who is the most senior person. Then, there is a Clinical Manager, who, by definition, has to be a qualified doctor, but reports to the CEO who can be anybody. Then, there is a Nursing Manager, who is the most senior nurse in that hospital, who must also report to the CEO who can be anybody. That is one of the things that cause conflict… That being a very serious indictment within the health care system… how that thing happened. It was a terrible mistake which we need to correct”.
In scrapping this model, the Health Minister could not be drawn on how many hospital CEOs will be affected.
“To discuss somebody’s employment here in the press conference without them having been told, might have legal implications. So, I’m restricted. Please understand that. I’m not running away from this. We promised people that if you’re affected, you’ll be written a letter and hear from that letter what is being said”, he told a media briefing in Pretoria.
In future, Motsoaledi said, no hospital will be managed by anyone at a rank lower than Level 12. Furthermore, central hospitals will not be managed by anyone at a rank lower than Level 15, which is the level of a Deputy Director-General in the public service. Advertisements for new hospital managers are likely to come out in conjunction with the launch of the National Health Insurance proposal on Wednesday. The Health Minister also said that the Department is working on improving the condition of nursing colleges and accommodation for nurses, following the Nursing Summit earlier in the year.
“We have identified 122 nursing colleges in the country. Seventy-two of these will be refurbished, improved, extra space be added where necessary, and we will deliver these by the end of this financial year. The total cost for these 72 facilities is projected to be R272 million”.
Government’s expenditure on TB medication has also gone down. Motsoaledi announced that the Health Department has managed to negotiate a significant reduction with TB medication manufacturers. This follows last year’s reduction of government’s expenditure on antiretroviral drugs, which went down a massive 53%, resulting in a saving of R4.7 billion.
“We are announcing a further reduction of an aggregate of 18 percent in anti-TB medication and antibiotics. That amounts to a saving R242 million. We will continue with our resolve to reduce the cost of health care”, said Motsoaledi.