Health and Hospital Management

Biography

Biography: Christo Heunis

Abstract

Apartheid’s consequences for the South African health system and health care included the creation of a highly inequitable and discriminatory system – based on race, class, geographic area – with differential access, quantity and quality of health services for the wealthy and deprived. The policy directions and reforms of the post-apartheid dispensation have centred on increasing access to health care for all citizens based on the principle that “[p]ublic services are not a privilege in a civilised and democratic society; they are a legitimate expectation”. Nontheless, stark provincial, rural-urban and private/public inequalities continue to characterise the distribution and numbers of hospitals and beds. All three inequality dimensions are exacerbated by exodus of HRH: from public to private and NGO hospitals, to richer/better resourced provinces and to other countries. In the case of medical practitioners, specialists and pharmacists the increase in numbers since 1994 have been substantially lower than the population increase, and in the case of nurses just matched it. However, the absolute numbers of health professionals and available funding are not the central problems of the South African health system, but rather the vast inefficiencies in management and a divided health care system, with ever-more obvious distinctions between the public and private sectors in terms of access and quality. If the current policy direction towards national health insurance is to be successful, more equitable sharing of resources between the public and private sectors, major initiatives in management skills development – especially in public hospitals – and public-private partnerships in the provision of hospital services are required.