ETD Collection

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    Lean healthcare: a cross-section of South African ARV clinics
    (2018) Chatur, Sabrina
    The aim of this study is to assess waste in Anti-Retroviral (ARV) Clinics. This is against the background of an overburdened public sector – that serves a large percentage of the population in South Africa. South Africa is home to the to the world’s largest epidemic with approximately 7,06 million - 18.0% of general population, living with HIV as of 2017 (1). The objective of the study is to identify and categorise the drivers of waste present ARV Clinics - to evaluate the resultant impact of waste on the governance and administration of ARV Clinic operations as well as service delivery to the patient. Frameworks have been developed to measure and assess waste – with the hope that they will pave a pathway for the introduction of lean in ARV Clinics and in time the public health system. To achieve this, the research employs a qualitative analysis design approach incorporating both primary sources (multiple case studies) and secondary sources (academic publications and grey literature) of data. The study found that there is an abundance of waste in the daily operations of the ARV Clinics – there are very few people in the clinics and hospitals who ‘see’ these wastes because there is a need to develop the capabilities of the staff, as they are the essential foundation for improving partnerships, processes and the provision of service. However, the waste did not only exist at operational levels – the biggest potential for elimination of waste laid at the top, with the National Department of Health (NDoH), where policies and budgets are rolled out that affect what happens to the ARV clinics – a holistic approach to transformation needs to be considered. The research provides a contribution to knowledge in three key areas: firstly, through the development of frameworks, secondly through the validation of the frameworks via multiple case studies; and thirdly suggestions that provide a narrative that explain the link between waste - overall performance of ARV Clinics and the quality of service to patients.
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    A discussion on the ethical complexities of micro-level decision making in the South African private health insurance industry.
    (2017) Cazes, Aerelle Liëtte
    Health and, by extension, healthcare is accepted to be a valuable and important social good that is both a good in and of itself, as well as necessary to achieve life’s goals. Its fair distribution is therefore properly the subject of ethical concern and in the era of modern medicine where costs and potentially limitless treatments exceed available resources, rationing healthcare has become an unavoidable necessity. Since such rationing implies that not everyone’s needs or preferences can be met, a fair and just way of rationing healthcare is a widely debated and controversial topic that, to date, remains unresolved. Where third-party private funding organisations are tasked with these rationing responsibilities, the ethical complexities are compounded by perceived conflicts between the ethical frameworks that govern corporate organisations versus those that govern healthcare. Given the apparent inability of normative theories to resolve the problem of how to ration healthcare fairly, there has been a shift in thinking to considerations of procedural justice and a dominant model, Accountability for Reasonableness (AFR), has emerged as the favoured procedure for healthcare decision-making. The report shows why health is an important social value and examines the key models and principles that dominate the rationing debate as well as why the conflict between healthcare ethics and organisational ethics create additional complexities that must be considered when making these funding decisions. Furthermore it explores the rationales for resorting to procedural accounts with specific emphasis on the parameters and validity of AFR. The report concludes that even though the AFR framework may be a legitimate and just process that can effectively frame decision-making and provide a platform to drive transparency and consistency, like most procedural accounts, it does not guarantee that the outcomes it produces are necessarily fair or just. Therefore a straightforward application of AFR cannot resolve the healthcare rationing debate which should, given its ethical complexity, continue to appeal to the important ethical principles that currently govern the field.