Here is a report based on interviews with clinical staff at South African district hospitals about their leadership roles:
2014_Improving public hospitals through clinical leadership
The study was conducted for the Municipal Services Project which is located at the School of Government, University of the Western Cape, Republic of South Africa, and funded by the International Development Research Centre of Canada.
Here are the powerpoint slides for a presentation I gave on behalf of colleagues at the most recent Prince Mahidol Award Conference which was held in Thailand between 27 and 31 January 2014.
The theme of the conference “Transformative Learning for Health Equity” and it focused on issues around the production of human resources to achieve universal health coverage. You can look at more presentations from the conference on the conference website.
The title of our paper was: Doherty J, Couper I, Campbell D, Walker J. 2014. Transforming rural health systems through clinical academic leadership: lessons from South Africa: PS2.1 Jane Doherty
Here is some information on my latest policy brief, as well as the report on which it is based:
EQUINET Policy Brief 35: Legislation on the for-profit private health sector in East and Southern Africa
Doherty J (2013) with UCT HEU, TARSC. Wemos Foundation, Policy brief 35, EQUINET, Harare
While the private sector contributes new resources to the health system, international evidence shows that if left unregulated it may distort the quantity, distribution and quality of health services, and lead to anti-competitive behaviour. As the for-profit private sector is expanding in east and southern African (ESA) countries, governments need to strengthen their regulation of the sector to align it to national health system objectives. This policy brief examines how existing laws in the region address the quantity, quality, distribution and price of private health care services, based on evidence made available from desk review and in-country experts. It proposes areas for strengthening the regulation of individual health care practitioners, private facilities and health insurers. A more detailed discussion paper (#87) on the laws and information in the brief is available at www.equinetafrica.org/bibl/docs/EQ%20Diss%2087%20Private%20HS.pdf.
EQUINET (the Network on Equity in Health in Southern Africa) have just published an editorial and report on legislation governing the for-profit private health sector in east and southern Africa. To access these publications, click on the links below:
Doherty J. 2013. We cannot afford to leave the for-profit private health sector unregulated in Africa (editorial). EQUINET Newsletter 150: 01 August 2013. Available at: http://www.equinetafrica.org/newsletter/
Doherty J. 2013. Legislation on the for-profit private health sector in east and southern Africa. EQUINET Discussion Paper 99. Harare: HEU, EQUINET. Available at: http://www.equinetafrica.org/bibl/docs/Diss%2099%20privsector%20laws%20Aug2013.pdf
My colleagues – Ian Couper, David Campbell and Judi Walker – and I have just published a new article in Rural and Remote Health.
It is called “Transforming rural health systems through clinical academic leadership: lessons from South Africa.”
Here is the PDF version: RRH article_clinical academic leadership.
My latest book chapter has just been published:
Doherty J, McIntyre D. 2013. Addressing the failings of public health systems: should the private sector be an instrument of choice? In: Surender D, Walker R (eds). 2013. Social policy in a developing world. Cheltenham, UK: Edward Elgar.
I have just published the following open source article on mid-level medical health workers (Clinical Associates) in South Africa:
Doherty J, Conco D, Couper I, Fonn S. (2013) Developing a new mid-level health worker: lessons from South Africa’s experience with Clinical Associates. Global Health Action; 6: 19282. Available at: http://dx.doi.org/10.3402/gha.v6i0.19282
South Africa has begun producing a new type of health professional – a clinical associate.
You can read a bit more about clinical associates here but, in brief, they are people ideally suited to working in hospitals, helping doctors carry out some of their tasks – like dealing with emergencies and doing procedures.
Clinical associates don’t replace doctors or nurses – they work with them, sharing some of their workload, and allowing them to concentrate on the tasks for which only they are qualified.
There is no doubt that more doctors and nurses need to be trained and recruited into the South African health system. But will this alone solve the country’s staff shortages? Realistically, how many decades will it take to fill all the country’s vacant posts? Can the country afford a system exclusively based on doctors and nurses? Is this even necessary?
It takes less time to train a clinical associate. They can become very good at what they do because they focus on a special set of skills and are supervised by doctors. They are recruited from rural and disadvantaged communities. Health workers a bit like them have made an enormous difference to many health systems around the world, especially in Africa but even in the United States.
So clinical associates could do a lot to address staff shortages in the public sector, especially in district hospitals. They could help bring good quality care closer to communities in a way that is affordable for the country. Along with other initiatives – such as strengthening hospital management – they could help produce public services that live up to the aspirations of the NHI policy.
So why isn’t there more excitement about this new category of health professional? Why don’t we hear about them in the press or from government spokespeople?
Clinical associates are noted as a priority in the latest government human resource strategy but the future of clinical associates and the strategy of NHI need to become much more closely intertwined.
I would like to get into contact with researchers, policy-makers and legal experts working on appropriate policies and legislation governing the for-profit private health sector in Africa.
Or perhas you do work on other low- or middle-income countries that might be relevant to the African situation?
On the ‘About Jane Doherty’ tab above you will find my e-mail address if you want to let me know about the work you are doing or have research or reports to share.
On the ‘Private health sector’ tab you will find my own work on the private sector (with links to the electronic versions where available). Of particular interest might be:
- FORTHCOMING: A situation analysis of private sector legislation in East and Southern Africa which is still in an early draft form
- FORTHCOMING: Doherty J, McIntyre D. (2013) Addressing the failings of public health systems: should the private sector be an instrument of choice? In: Surender R, Walker R. (2013) Social policy in a developing world. Cheltenham, UK: Edward Elgar
- Doherty J. 2011. Expansion of the private for-profit health sector in East and Southern Africa. EQUINET with HEU, UCT and TARSC Policy Brief 26. Harare: EQUINET.
- Doherty J. 2011. Expansion of the private health sector in East and Southern Africa. EQUINET Discussion Paper 87. EQUINET: Harare.
- A report summarising research on the for-profit private health sector in South Africa from the 1980s to 2003: Doherty J, Steinberg M. 2003. Priority health care information needs for reform: what role for BHF? Johannesburg: Board of Healthcare Funders.