Report on governance and management in SA health system launched

1 July 2024 - Wits University

The Academy of Science of South Africa released the report, "Achieving Good Governance and Management in the South African Health System" on 28 June 2024.

Wits Professor of Public Health, Sharon Fonn was one of the seven professionals drawn from various disciplines in the South African health system who conducted the study.

The consensus study explores critical governance issues that impact the South African health sector and it provides actionable recommendations for change.

Commissioned in September 2020, the study embarked on an examination of the pillars underpinning good governance.

The report highlights significant challenges, including leadership instability, lack of transparency, insufficient accountability mechanisms, and pervasive corruption.

Despite these obstacles, the study acknowledges positive examples of effective governance, which serve as a foundation for the panel's comprehensive recommendations aimed at systemic reform.

Fonn says, “Access to quality health care is important for all in South Africa. It meets basic needs and is valuable in and of itself, but it also promotes economic growth, and is our constitutional right. Good governance and management of the health systems is essential to providing quality health care. It is costly at many levels, mostly in building the structures, relationships and trust that are required. But doing nothing is much more costly to South Africa.”

The report identifies several core areas of concern:

• Strategic Vision and Policy Design: the absence of a unified public value mission and inadequate delegation of authority impede effective governance.
• Transparency and Accountability: political interference and lack of transparent processes undermine accountability and trust in the health system.
• Participation and Consensus Orientation: limited community involvement and top-down management approaches restrict stakeholder engagement and decision-making.
• Combating Corruption: corruption remains a significant issue, exacerbated by insufficient protective measures for whistle-blowers and lack of decisive action against corrupt practices.

The panel offers a roadmap for reform, emphasising the necessity of:

• Defining and communicating a clear public value vision.
• Updating legislation to insulate governance structures from vested interests.
• Delegating authority appropriately at all levels.
• Ensuring merit-based appointments and professionalising the civil service.
• Implementing fit-for-purpose systems to support managers and leaders.
• Fostering authentic community participation.
• Supporting managers at every level so that they have the resources, understanding, and ability to build teams and attend to the relationships that make complex systems work, focusing on both the people within the health system (providers) as well those whom the health system serves.
• Acting decisively against corruption and protecting whistle-blowers.

Implementing these recommendations will require concerted effort from all stakeholders within the health system. The cost of inaction is great, potentially jeopardising the realisation of universal health coverage and the constitutional commitment to health care access and equality for all South Africans.

ÍøÒ×ÌåÓý the Academy of Science of South Africa

The Academy of Science of South Africa (ASSAf) was inaugurated in May 1996. It was formed in response to the need for an Academy of Science consonant with the dawn of democracy in South Africa: activist in its mission of using science and scholarship for the benefit of society, with a mandate encompassing all scholarly disciplines that use an open-minded and evidence-based approach to build knowledge. ASSAf thus adopted in its name the term ‘science’ in the singular as reflecting a common way of enquiring rather than an aggregation of different disciplines. Its members are elected on the basis of a combination of two principal criteria, academic excellence and significant contributions to society. The Parliament of South Africa passed the Academy of Science of South Africa Act (No 67 of 2001), which came into force on 15 May 2002. This made ASSAf the only academy of science in South Africa officially recognised by the government and representing the country in the international community of science academies and elsewhere.