Performance management and public policy : the case of the health sector in South Africa

Abstract

The South African healthcare sector stands at the threshold of major restructuring in an attempt to address inadequacies as a result of fragmentation of health services in apartheid South Africa. The performance of health services, particularly in more remote areas, has decreased and has led to reduced quality and effectiveness of health services. For individuals residing in rural communities, access to health services can be arduous. Delivery of essential services has to meet the needs of marginalised people who live in remote areas. The department of health is faced with growing expectations from citizens to use resources effi ciently and effectively so that healthcare can be afforded and accessed by all. National Health Insurance (NHI) aims to introduce reforms to improve the provision of healthcare.

The health sector is reputed to be good at formulating policies, discussing ideas, making recommendations and spending resources, but poor on implementing policies. The government insists that the policy framework is transparent and well-defi ned and that what is needed is effective implementation. Regrettably, the transition of policy into practice is more complex than the perceived judgement of government. The results of this study may be useful not only to the case study institution, but to all District Hospitals, especially the Department of Health and the public management sector and may assist in taking the NHI forward.