Memorandum

TO: Mr. Joseph Nkosi

FROM: Rushi Dave

DATE: 14th October 2019

SUBJECT: Strategic Planning in Lesedi District, South Africa

Summary

Planning is a major challenge in the discharge of health services. The linkage between the national health department and the provincial health department is weak, resulting in mixed messages at the sub-district level. The use of clinicians as sub-district managers and handing them administrative duties without the necessary skills, prevents them from fulfilling their duties effectively. Planning needs to be centralized and the sub-district managers selected from administrative individuals as opposed to clinicians or have the clinicians undergo training.

Background

Disjointed planning is one of the major problems in the strategic planning process and this affects the delivery of health services at the district level. The disjointed nature of the planning process can be seen in how fiscal planning is conducted from the top level downwards. The national department of health usually sets out its priorities for the upcoming fiscal year and around the same time the provincial health department sends out its annual performance plan detailing the expectations that the province has for the districts in the upcoming year. Receiving instructions from two bodies should not actually be a problem as it could be for emphasis purposes and to ensure that the administration at the lower levels fully understands what is expected from them at the higher levels. However, it becomes a problem when the priorities are not similar as is usually the case. The national department of health and the provincial health department are not always reading from the same page. This creates a problem at the district and the sub-district level in terms of their planning and budgeting processes. Officers at the district level are not sure whether to align their goals and objectives with the priorities for the national department of health or those of the provincial department of health. The result is usually confusion at the administrative level which creates unnecessary problems in the administration of health services in the country. The priorities at the national department of health, for example, could be to reduce HIV/Aids transmission rate while the provincial health department could have its priorities set around raising cancer awareness to reduce the mortality rate through early screening and detection. Both are noble goals, however, the budget cannot afford to prioritize both and hence one has to make way. The end result then becomes that one district prioritizes cancer management while another prioritizes HIV/Aids management. It ends up preventing the country from making proper strides in the management of either due to the disjointed nature of the planning process.

I have also noted that there is a major problem in the definition of job roles and specialization especially at the sub-district level. I have noted that sub-district managers are often protected from fulfilling their roles effectively due to a lack of adequate skills. Sub-district managers usually have a clinical background and they are then expected to fulfill administrative functions effectively. This is made even harder by the fact that most of the goals and objectives sent to the sub-district managers are highly political. The political nature of these objectives coupled with the unskilled nature of the managers on administrative functions makes it hard for them to effectively fulfill their functions. The sub-district managers are thereby handicapped in their operations by a lack of proper training and skills in the fulfillment of some of their job roles. This is then transferred to the lower levels where persons such as chief nurse officers do not receive clear guidelines on how to act in order to meet the year’s goals and objectives. The fact that unskilled persons are expected to translate political objectives and then set out the job descriptions for the respective junior officers makes it very challenging for the programs to run effectively.

Recommendations

I recommend that the administrative side of the health sector be fully separated from the clinical side as this is creating major problems for the sector. It is only fair that a person that understands the administrative role and is fully fitted with administrative skills is charged with the responsibility of translating political objectives. These roles are best suited for individuals with background in management and administration as opposed to clinical backgrounds. It matters not whether it is the health sector but clinicians should not be charged with administration duties. Clinicians should be left to discharge clinical services and only take up administrative roles after they have been well trained and equipped with the right administrative skills. I thereby propose that sub-district managers are replaced by persons with administrative skills and qualifications or these managers undergo proper training to equip them with skills. This will be the only way that the administrative side of the health sector will be run effectively. I also recommend that a radical centralization of the national health department and the provincial health department occurs in order to stop the confusion in the planning process. The provincial health department should seek the guidance of the national health department when coming up with goals and priorities for the year to stop sending mixed messages to the sub-district managers and making their job even harder.

Conclusion

I hope you will relay these recommendations to the necessary individuals to ensure that health services in the country improve and avoid some of the embarrassing challenges facing the sector.