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By SHADRACK AYUB KATUU Submitted in Accordance with the Requirements for the Degree of DOCTOR of LITERATURE and PHILOSOPHY in T

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By SHADRACK AYUB KATUU Submitted in Accordance with the Requirements for the Degree of DOCTOR of LITERATURE and PHILOSOPHY in T MANAGING RECORDS IN SOUTH AFRICAN PUBLIC HEALTH CARE INSTITUTIONS – A CRITICAL ANALYSIS by SHADRACK AYUB KATUU submitted in accordance with the requirements for the degree of DOCTOR OF LITERATURE AND PHILOSOPHY in the subject INFORMATION SCIENCE at the UNIVERSITY OF SOUTH AFRICA SUPERVISOR: PROF T B VAN DER WALT February 2015 Summary The historical evolution of South Africa’s health sector, dating back to the 17th century, is significantly different from that of other African countries. Throughout the four centuries of development there have been numerous advances in health policy, legislative instruments and health system progress. Against this background this dissertation critically analysed the management of records in public health care institutions in South Africa. The study did this by addressing three objectives: assess the legislative, policy and regulatory contextual framework of South Africa’s health care system; assess the effectiveness of records management within public health care institutions; and identify appropriate interventions to address the challenges facing records management in the health care system. The study used purposive sampling to identify respondents with diverse expertise in three main sectors: the public sector, the private sector as well as in academic and research institutions. Using interview research technique the study solicited data that was analysed in order to provide a composite picture in addressing the research objectives. The analysis of data revealed three overarching themes. First, there is substantial legislative and regulatory dissonance in the management of health records in the country. While there are extensive legislative, regulatory and policy instruments that could be used to manage records, many lack coherence with records management issues such as records retention. Second, understanding the complex interplay of different legal and regulatory instruments is a critical first step, but it remains the beginning of the process towards building a sophisticated implementation process. For this process to be successful, study respondents argued that records compliance would have to be the backbone of all other compliance processes. Third, while there were substantial areas of weakness in the management of records in South Africa’s public health sector, there have been a number of pockets of excellence. These include the efforts towards complying to access to information legislation by the Limpopo Department of Health and Social Development as well as the successful introduction of Enterprise Content Management systems in health care institutions by the Western Cape Department of Health. Key terms : Africa, Apartheid, Electronic Document and Records Management, Electronic Health Records, Electronic Medical Records, Health Care, Health Information Management, Health Information System, Health Records, Information Management, Medical Records, Records Management, Research Methodology, South Africa Page | ii Acknowledgement This has been a long journey and wouldn’t have ended successfully without key individuals. I would like to acknowledge Prof Thomas van der Walt for patiently reading through all the copious amounts of material I wrote including the content that never finally made it into this dissertation and being part of this long journey the last 9 years as supervisor. I am grateful to my parents, Mr Austine Katuu and Mrs Christine Katuu and my three siblings: Elizabeth, Karen and Phoebe, who have supported the last decades of my sojourn through different parts of the world pursuing academic and professional excellence. Everyone needs peers that challenge and admonish. I am grateful to my brothers Ntate Sello Hatang and Ntate Verne Harris, through whom I was introduced to the great country of South Africa from 2001 and from whom I have received consistent encouragement through the years of this academic expedition. Ntate Harris, one of a rare breed of archival philosophers, your thoughts have consistently been thought provoking. Ntate Hatang, a truly inspirational leader of our generation and down-to-earth intellectual mind. Thank you both for listening to all my ideas develop over the last decade and a half and offering comradery. To Ntate Gustavo Castaner who has, in the last four years, become like family – this is the end of my journey and as you begin yours in similar fashion, I hope it doesn’t take as long. Prof Mpho Ngoepe who was not only been patient with advice but is a true professional trailblazer on the African continent. Thanks to Thembi Hatang and the Hatang family for the Kenyan-South African bilateral support. Herr Dk Leopold Kammerhofer that offered great wisdom and insight the last two years, Dankeschön! Asante sana Bwana K Rotiken, Bwana M Mgonja na Bwana R Njoroge, hii kitu imeisha! Sasa tunaganga yajayo! And to the numerous professionals that have paved the way including such as: Dr A Boly, Dr A Josias, Dr A Lusigi, Dr A Segobye, Dr C Rogers, Dr G Mukupa, Dr J Evans, Dr K Omari, Dr L Hanmer, Dr L Millar, Dr M Masike, Dr M Majoro, Dr M S Stephenson, Dr N Adeya, Dr N Hussin, Dr P Mekgwe, Dr P Svärd, Dr R Ngugi, Dr S McCausland, Frau Dk M Reiss, , Prof A Gilliland, Prof A Thurston, Prof B Onyancha, Prof D Ocholla, Prof D Wallace, Prof G Wright, Prof H Kemoni, Prof H MacNeil, Prof J Wamukoya, Prof K Anderson, Prof L Duranti, Prof M Majanja, Prof N Mnjama, Prof R Hopkins, Prof S Mutula, Prof S Whittacker, Prof T Eastwood, and Prof V Lemieux. And two truly inspirational people in my professional life who passed away, Dr Marian Hoy of Australia and Dr Terry Cook of Canada. And thanks to all friends and colleagues in different parts of the world too numerous to name (because this would constitute yet another chapter of this dissertation) but I name a few: A Griffin, A Kamunde, A Killmeyer-Oleche, A Kufwa, A Miller, A Webster, B Abbott, B Faye, C Anyanwu, C Kirkwood, C Mugoh, C Mwafuga, D Okoth, D Oppermann, D Smit, D Terry, E M Pretorius, E Dobie-Sarsam, E Goh, E Page | iii Mwangi, E Shaffer, E Wokabi, H Keah, H Leggat, H Shete, I Brink, I Deserno, I de Vaal, I Zabaar, J Fiam-Coblave, J Hunter, J Lowry, J Maluleka, J Marek, J McDonald, J Odendaal, K Kukubo, L Davies, L Gaparayi, L Mnisi, L Nduta, L Venter, M Fronda, M Mulei, M Sehlopelo, N Bikitsha, N Kota, N Seyffert, N Somhlahlo, P Giordani, P Marais, P Mullon, P Mulumba-Kikuni, P Salela, P Tharage, R Alger, R Kubiha, R Thompson, S Makhubela, S Müllner, S Peleowo, S Thompson, S Xulu, T Jongwe, T Steinmann, W Misiko, Y M Chong, Y Munge, Z Simelane, Z Y Sun and the Kiza family who were my next door neighbours in Vienna. I appreciate C Muraya and T Muraya for keeping life and living in perspective. I am grateful to Ambassador T Amolo, Ambassador M and Mrs D Oyugi as well as Ambassador T and Mrs M Seokolo for each offering their wise counsel. I thank the many other friends that I may have omitted for making the different phases of this journey bearable. Am grateful to all the professional colleagues at the Nelson Mandela Foundation in Johannesburg, the International Monetary Fund in Washington DC, the International Atomic Energy Agency (particularly in the Archives and Records Management Section) and other UN agencies in Vienna as well as friends in those and other cities in the world who have, over the years, inquired about progress and offered goodwill. Again to my mother, Mrs Christine Katuu for patiently reading drafts of the full dissertation from cover to cover, twice! Thank you Kerry Harris for very insightful editorial advice and being available to act as a sounding board for over a decade. Dedication This dissertation is dedicated to celebrating Nelson Mandela’s legacy. Tata am grateful for the life transforming privileged of working for you at the Nelson Mandela Foundation for nearly five years. This dissertation is a way of giving back to a country you dedicated your life to transforming and I hope your vision lives on not only amongst South Africans but in my own country of Kenya and other parts of the world. You taught us many things including the fact that “it is easier to change others than to change yourself”. Your vision for social justice is one each of us has to take as an individual call. I take the challenge. Thank you Madiba! Ndiyabulela Tat'omkhulu! Asante! Chawucha!. Page | iv Student number: 359220068 I declare that MANAGING RECORDS IN SOUTH AFRICAN PUBLIC HEALTH CARE INSTITUTIONS – A CRITICAL ANALYSIS is my own work and that all the sources that I have used or quoted have been indicated and acknowledged by means of complete references. ________________________ ___27th February 2015_______ SIGNATURE DATE (Mr S A Katuu) Page | v Table of Contents SUMMARY II ACKNOWLEDGEMENT III DEDICATION IV TABLE OF CONTENTS VI LIST OF FIGURES XIV LIST OF TABLES XVI LIST OF ABBREVIATIONS AND ACRONYMS XVIII CHAPTER 1 – INTRODUCTION 1 1.1 BACKGROUND TO THE STUDY 1 1.1.1 SOUTH AFRICA PRE -1994 2 1.1.2 SOUTH AFRICA POST 1994 5 1.1.3 A HISTORY OF THE HEALTH SECTOR IN SOUTH AFRICA 10 1.2 STATEMENT OF THE PROBLEM 11 1.3 RESEARCH PURPOSE AND OBJECTIVES 13 1.4 JUSTIFICATION OF THE RESEARCH STUDY 15 1.4.1 AN OUTLINE OF MASTERS AND DOCTORAL STUDIES CARRIED OUT IN SOUTH AFRICA 16 1.4.2 AN OUTLINE OF MASTERS AND DOCTORAL STUDIES CARRIED OUT IN THE REST OF AFRICA OUTSIDE SOUTH AFRICA 17 1.4.3 AN OUTLINE OF MASTERS AND DOCTORAL STUDIES CARRIED OUT BEYOND AFRICA IN THE REST OF THE WORLD 17 1.4.4 ORIGINALITY OF THIS RESEARCH STUDY 19 1.5 RESEARCH METHODOLOGY 19 1.6 LIMITATIONS OF THE STUDY 22 1.7 DEFINITION OF IMPORTANT
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