3. Electronic Theses and Dissertations (ETDs) - All submissions
Permanent URI for this communityhttps://wiredspace.wits.ac.za/handle/10539/45
Browse
2 results
Search Results
Item Regulating the employment of doctors within the private sector in South Africa: a policy analysis(2018) Mosam, AtiyaIntroduction: 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.Item Assessment of potential barriers to medicines regulatory harmonization in the Southern African development community (SADC) region(2016-04-28) Calder, AmandaBackground The World Health Organization (WHO) defines medicines regulation as the “promotion and protection of public health by ensuring the safety, efficacy and quality of drugs, and the appropriateness and accuracy of product information” (1). Medicines regulation is a key function in the realisation of the right to essential medicines. However, a satisfactory level of harmonization of regulatory activities has not been achieved in the Southern African Development Community (SADC) region as yet. Objectives The study evaluated the current status of medicines regulatory harmonization within the SADC region, as well as explored perceived barriers to regulatory harmonization and potential strategies to address these. Methods A cross-sectional exploratory study design with qualitative techniques, as well as an inductive approach was used. In-depth, semi-structured, face-to-face interviews with interviewees from the SADC Secretariat, the African Medicines Harmonization (AMRH) Initiative and the Southern Africa Regional Programme on Access to Medicines and Diagnostics (SARPAM) was used, involving secondary formal qualitative approaches to identify the emergent themes, was utilised initially. A questionnaire was formulated and adapted using secondary data collected from the face-to-face interviews, then piloted. Questionnaires were sent to senior members of all 15 regulatory authorities belonging to SADC, including registrars and deputy registrars. Theoretical and analytical codes were identified from repeated ideas, concepts or elements. Codes were grouped into concepts, and then into categories. Trend analysis was conducted, involving an in-depth analysis of patterns. Results Barriers to regulatory harmonization in the SADC region perceived by participants included i) deficiencies in governance and leadership within the SADC Secretariat, ii) human resource and technical capacity constraints, iii) limited financial resources, iv) lack of political will within SADC governments, v) lack of intra-SADC relationships, vi) risk-benefit analysis differences in assessment of applications and bias according to local population needs, as well as vii) different guidance documents and legal frameworks among member countries. Strategies identified to address these included i) using other harmonization initiatives as models, ii) application format harmonization and African Union (AU) Model Law adoption, iii) redirecting focus of harmonization to information sharing and technical matter rather than complex legislative frameworks, iv) regulator initiatives of harmonization instead of SADC secretariat reliance, v) World Bank Agreement adoption, vi) human resource capacity development and vii) convergence of guidelines instead of complete harmonization of all regulatory requirements. Conclusions The findings in this study suggest that it may be necessary to redirect the focus of harmonization to more readily achievable activities and aim for convergence of guidelines. Regulatory harmonization is possible if barriers to it are addressed.