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Transferability of Policies and Organisational Practices Across Public and Private Health Service Delivery Systems

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Transferability of Policies and Organisational Practices Across Public and Private Health Service Delivery Systems Transferability of Policies and Organisational Practices across Public and Private Health Service Delivery Systems: A Case Study of Selected Hospitals in the Eastern Cape: Exploring Lessons, Ambiguities and Contradictions By Mziwonke Milton Mpofana Student number: 8744401 This thesis is submitted to the School of Government, Faculty of Economic and Management Sciences, University of the Western Cape in fulfilment of the requirements of the degree of Doctor of Philosophy. Supervisor: Professor Gregory Ruiters December 2016 i Declaration I, Mziwonke Milton Mpofana declare that this thesis represents my own unaided work. It is submitted to the School of Government, University of the Western Cape. I have not copied the whole or any part thereof and it has never been submitted to any other institution of higher learning for any other degree. I have acknowledged and fully referenced all the sources used. All opinions expressed herein do not necessarily represent those of the university. Name: Mziwonke Milton Mpofana ii Acknowledgements I would like to acknowledge and thank the following people for their invaluable contributions and setting aside time from their busy schedules to assist me in various ways in this research endeavour: External Readers and my Supervisor (Prof Ruiters) Ms. Carol Moshesh, librarian of the East London branch of the University of South Africa; Dr Mthandeki Xhamlashe, the CEO of the Cecilia Makiwane Hospital; Ms. Nondyebo Zondani, a Senior Professional Nurse at the Cecilia Makiwane Hospital; Dr Rolene Wagner, the CEO of Frere Hospital; Ms. Marriane Stigling Nursing Manager at Port Alfred Private Hospital; Ms. Gloria Murison, the General Manager at Netcare Greenacres Private Hospital; Mr. Ntshebe, a representative of labour organisation (NEHAWU) at Cecilia Makiwane; Mr. Mjikwa, a representative of NEHAWU at Frere Hospital; Mr. Lindile Ngqunge a representative of NEHAWU at Port Alfred Private Hospital; Mr. Azola Ndzube a representative of NEHAWU at Netcare Greenacres Private Hospital; Ms. Natalie Seymour (UWC) Phumzile Zitumane, a friend and Management Executive of FHL Leadership and Management Consultants for facilitating my access to the Heads of the public hospitals. iii A sincere word of gratitude to Ms. Nonkqubela Siyo, Secretary to the East London Hospital Complex Research Committee who facilitated the consideration and approval of my application to conduct research in Cecilia Makiwane and Frere hospitals; Professor Monde Mbekwa of the UWC Faculty of Education, my former teacher and now a close friend for assisting me with finding an editor during the awkward festive period. A special word of gratitude to Ms. Zoleka Putye and Nomaxabiso Mbekisa, my former Office Manager and Personal Assistant respectively for the research, administrative support and encouragement; Gaster Sharpley, the Head of the Eastern Cape Department of Human Settlements my manager and fellow candidate for his understanding and encouragement. Finally yet importantly, a special word of gratitude goes to Professor Gregory Ruiters for his support, advice and guidance in the preparation of this thesis. iv Dedication I dedicate this study to my late parents Douglas and Nontsuntsu Mpofana for inculcating me with values of discipline, hard work, self-reliance, love for fellow human beings and giving me space to optimize my potential to become what I want to be and to never forget the less privileged. To my elder brother Mthobeli Mpofana―uBhuti‖ for contributing immensely in shaping my upbringing and for always asking me when am I doing my PhD and recently (towards completion of this thesis) for jokingly saying family members must practice calling me Doctor. Also, to Thando Mguli the Head of the Western Cape Department of Human Settlements and my greatest friend for always checking on my progress with great sense of urgency for me to complete this thesis so that he can call me Doctor or at least Doctor-designate whilst I was finalizing this thesis. My nephew Thulani and nieces Liziwe and Nelisa for their admiration and looking up to me as their inspiration. Finally, and yet importantly, to my life partner Xolisa ―Nxoza‖ for her encouragement, support and assistance in various respects; and to my children Nomsa, Wongalethu, Ayanda, Sinalo and grand-daughter Mihle for their appreciation of my academic pursuit and understanding when I could not give them my full attention due to this research project and work commitments, I wish to thank all of you profusely and may God bless you abundantly. v Key Words Public-private-partnerships; best practice, policy transfer, service delivery models, health services, governance, labour relations, Eastern Cape Province vi List of acronyms APP Annual Performance Plan BBBEE Broadbased Black Economic Empowerment BCMM Buffalo City Metropolitan Municipality. BRICS Brazil-Russia-India-China-South Africa CEE Central and Eastern European countries DENOSA Democratic Nurses Organisation of South Africa CMH Cecilia Makiwane Hospital EBPM Evidence Based Policy Making EC Eastern Cape JSE Johannesburg Securities Exchange HASA Hospitals Associations of South Africa HOSPERSA Health and Other Services Personnel Trade Union of SA HPCSA Health Professionals Council of South Africa IMF Institutional Management Forum NEDLAC National Economic Development and Labour Council NEHAWU National Education, Health and Allied Workers Union NHI National Health Insurance vii NPM New Public Management NT National Treasury OSD Occupation Specific Dispensation PACS Picture Archive Communications System PFMA Public Finance Management Act PHC Primary Health Centre PMDS Performance Management and Development System PPPs Public- Private Partnerships PPPFA Preferential Procurement Policy Framework Act PSC Public Service Commission PSR Public Service Regulations SA South Africa SDIP Service Delivery Improvement Plan UK United Kingdom USA United States of America USAID United States Development Aid Agency WPTHS White Paper on the Transformation of the Health System WPTSD White Paper on the Transformation of Public Service Delivery viii WPTPS White Paper on the Transformation of Public Service ix List of Tables Table 1: Public versus private services Table 2: Motivations for Transfers Table 3: Stages in Transfers Table 4: Stages in Transfers Table 5: Statistics on private health sector professionals Table 6: Statistics on the medical aid schemes x Abstract Since the advent of South Africa‘s democracy in 1994 there have been several changes in the policy and legislative arena specifically promoting public-private-partnerships in the health sector. These initiatives have given rise to opportunities for inter-sectoral policy transfer under the rubric of ―best practices‖. This exploratory study examines the character, obstacles and contested nature of a selection of policy transfers between private and public health institutions in a single province of South Africa. The study looks at the dynamics at play around envisaged, current and past transfers of policies and organisational practices in relation to administrative systems and technologies used in four different hospital settings – two public and two private hospitals in the Eastern Cape Province of South Africa. This thesis explores the views of managers and labour organisations about policy transfer focusing on local contexts, and how various parties construct policy transfer, hence providing a perspective of policy at the ―plant‖ level. In this research, special focus is placed on different agents‘ role and understandings of their contexts and how and why policies move and contradictions of these developments. In- depth interviews were conducted at four major Eastern Cape hospitals. The thesis argues that in practice, policy transfer is messy, politicized and traversed by power and vested interests and that organised labour plays a key role in policy transfer process. The thesis focuses on the different philosophical/ideological underpinnings, socio-political values and operational environments in each sector. This study is designed to contribute to existing knowledge on practices particularly between the public and private sectors in order to widen the understanding of the complexity of transferability. xi Contents Chapter 1: Aims and rationale of the study ...................................................................................... 1 Chapter 2: International literature and theoretical framework ...................................................... 16 Chapter 3: South Africa’s public health sector governance issues and the Eastern Cape ............ 47 Chapter 4: South Africa’s private health sector: effectiveness and contested issues in policy transfer ....................................................................................................................................... 74 Chapter 5: Case Study of Greenacres Netcare Private Hospital ..................................................... 93 Chapter 6: Case Study of Port Alfred Hospital (a Private-Public Partnership) .......................... 120 Chapter 7: Case Study - Cecilia Makiwane (Public) Hospital ....................................................... 155 Chapter 8: Case Study of Frere hospital .......................................................................................... 199 Chapter 9: Analysis of findings of policy/organisational practices transfers across the public and private healthcare facilities ...........................................................................................
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