ETD Collection

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Now showing 1 - 4 of 4
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    Regulating the employment of doctors within the private sector in South Africa: a policy analysis
    (2018) Mosam, Atiya
    Introduction: Submissions to the Health Market Inquiry (HMI) postulated that the Health Professions Council of South Africa (HPCSA) regulations that prevent private hospitals from employing doctors is one of the reasons for high private sector costs. This study aimed to understand the current regulatory environment surrounding the HPCSA policy on employment of doctors and the implications of such a policy in light of the current health system policy reforms in South Africa. Methodology: The study was conceptualised as a policy analysis study with qualitative and quantitative components. The qualitative component consisted of document reviews and interviews with key stakeholders in order to investigate the current regulatory environment and implications of the regulations. The 20 stakeholders interviewed represented regulatory bodies, clinician associations, hospital groups, medical schemes and universities. The quantitative component consisted of a survey of doctors in South Africa to ascertain their views on the current HPCSA policy and its implications for clinical practice. A database of 21 065 doctors was obtained from MedPages and the survey yielded a response rate of 7.7%. Results: Whilst only 5 stakeholders viewed the HPCSA policy as increasing costs of care, 20 stakeholders felt that the policy impeded quality of care provided. 46.6% of doctors surveyed did not feel that employment would lead to decreased costs but only 30.6% agreed that the HPCSA policy did impede quality of care. Both stakeholders and doctors did not feel that employment of doctors would necessarily lead to unethical practices and loss of autonomy. Stakeholders and doctors were of the opinion that other measures such as multi-disciplinary practices and clinical protocols would be more effective in reducing costs and increasing quality of care but that conditional employment should be allowed to fill service gaps. Conclusion: Whilst key stakeholders and doctors were in favour of employment, the prevailing sentiment was that the policy should allow for employment of certain types of doctors’ or for certain services. It was therefore felt that the HPCSA policy needs to be amended, not only to allow conditional employment as highlighted above but more broadly to ensure that the HPCSA regulations support more innovative, cost effective, and integrated means of delivering patient care through multi-disciplinary practices and global fees.
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    Developing a constitutional law paradigm for a national health insurance scheme in South Africa
    (2014-08-21) Wayburne, Paul Allen
    The proposed National Health Insurance (‘NHI’) is the most extensive health policy initiative proposed by the South African government since 1994, to bridge the divide between the private and public health sectors. It is intended that the NHI will fund health care services for the entire population. Yet, despite its laudable goals, the implementation of NHI might be stalled by litigation concerning its constitutionality. In this thesis, I construct a constitutional paradigm within which such challenges can be understood. Departing from the premise that the Constitution places a positive obligation on the state to implement redistributive policies in the health sector in order to progressively realise the right to have access to health care services, the thesis identifies the tensions underlying the proposed implementation of NHI and aligns these to liberty-based and equality-based understandings of the right to health, respectively. This analysis takes place after having considered the history of health care reform in South Africa and debates on the desirability of NHI. The thesis then investigates and sets out the constitutional principles, values and standards embodied by the rights to equality, freedom and security of the person, and access to health care services, and considers the extent to which current the formulation of the proposed NHI adheres to these principles. Potential constitutional challenges to NHI by private sector interest groups are identified. These challenges are primarily concerned with adverse effects that the implementation of NHI may cause to current beneficiaries of private sector health services. It is argued that these adverse consequences will, for the most part, not justify a finding that relevant features of NHI are unconstitutional. This is either because they will not amount to an infringement of the relevant constitutional rights or because such an infringement will be capable of reasonable justification in terms of the general limitations clause. Only where the impairment of existing rights is disportionate or is related to some extraneous purpose inconsistent with constitutional rights and values will NHI not pass constitutional muster. Ultimately, the constitutionality of different features of NHI will depend on how the rights of those who already have access to health care services under the current health financing system are balanced with those who currently lack such access.
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    Lessons for policy and regulation from mobile applications in public health: the case of community health work in Daspoort, South Africa
    (2014-02-18) Holeni, Khopotso Cecilia
    The extraordinary growth in mobile telecommunications and advances in innovative application development has evolved into a new field of e-health, which includes mobile health (m-health) among others. m-Health is a new technology that is deployed in the Tshwane City health clinic named Daspoort as one of the national health insurance pilots. m-Health has revolutionised the way primary health care is administered in Daspoort in particular and in Tshwane City in general. The purpose of this case study is to establish lessons learned in the implementation of m-health as an alternative to bridging the health access gap. The study is meant to provide a library of lessons learnt and good practices in providing primary health services through the use of mobile technology, in this case m-health. The findings from this research suggest that m-health promotes efficiency and improves access. The results revealed that m-health poses challenges for practitioners in the absence of an e-health policy to fully cater for m-health. The implementation of m-health without a supportive legal framework is a risky exercise for both health professionals and community health-workers. Lack of clear guidelines from the National Department of Heajth in the implementation of m-health brings along a sense of vulnerability among health practitioners should things go unexpectedly wrong. In summary these are some of the key lessons learned: (i) Operating outside a mhealth policy and legal framework is very risky. (ii) Poor co-ordination of initiatives as a result of the lack of a collaborative policy and regulation results in silo efforts which lead to weak results. (iii) Community health workers, although they are part of the mhealth project are not covered by any legal framework; something that can expose them to criminal risk. (iv) m-health policy and legal vacuum result in a poor buy in of mhealth projects as managers are not accountable to take the project forward (v) Poor end of project planning as funded by donors leads to the death of m-health.
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    Assessing e-health policy development process using policy process network approach
    (2013-08-21) Mafani, Ncedisa
    The use of information and communication technologies in health care system can enhance equitable access to health care services and health information, even for the most marginalised communities in South Africa. The effective implementation of such applications in the health care system is dependent on the inclusive e-health policy development process bringing together the views of all the different role players. This research paper is a qualitative case study which looks into the extent to which the e-health policy development process in the Republic of South Africa has involved the active participation of all the relevant role players. The policy process network (PPN) approach introduced by Parag (2005) has been utilised to guide the methodology employed, the selection of the participants in the study, the design of the research instrument and the analysis of the results. The research study has looked at the extent to which the assessment of the e-health development process is aligned to the policy process network (PPN) approach. This policy assessment has not followed all the elements employed in the PPN as the policy under investigation is still in its infancy stage. However, the PPN approach employed has assisted in detecting the weaknesses of the e-health policy and the e-health policy process. If applied correctly, the framework can contribute to the formulation of a policy that is more effective. In view of the research findings, it emerges that there is a centralised approach into e-health policy development process. The centralised approach has shown its own weaknesses as highlighted in the limited participation of local government, communities and the healthcare implementers. The recommendations are important for the National and Provincial Department of Health policy makers to note the complexity of e-health which requires a sophisticated and encompassing coordination and collaboration system of all the networks. Without such a system the role players would just wield their power instead of working together in the e-health policy development process.