Faculty of Commerce, Law and Management (ETDs)

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    Operational challenges and financial sustainability of delivering dialysis services in South Africa
    (University of the Witwatersrand, Johannesburg, 2023) Avanasigan, Thareshni; Appiah, Erasmus
    The provision of dialysis services in South Africa presents a multifaceted landscape which is characterised by both operational challenges and financial sustainability concerns. This study explores the intricate dynamics and impediments faced within the healthcare system and focuses on the delivery of dialysis services. The reviewed literature examined the operational complexities which encompass limited access to resources, inadequate infrastructure, shortage of skilled personnel, and geographic disparities that impede the delivery of services. Moreover, the financial sustainability of dialysis services is a critical issue, and is compounded by the high costs for equipment, consumables, and maintenance, coupled with limited funding and reimbursement mechanisms. This study aims to shed light on the complexity surrounding the provision of dialysis services in South Africa. The challenges are synthesised and methods to enhance operational efficiency and acquire financial sustainability within the healthcare system is recommended
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    Health Financing and its Effect on the Equity of Healthcare Systems and Universal Coverage in Sub-Saharan Africa
    (University of the Witwatersrand, Johannesburg, 2023) Okaka, Damianus Ochieng; Ojah, Kalu
    This work examines the contribution of different arrangements for financing healthcare to health systems’ equity in Sub-Saharan Africa (SSA); with equity of the health system measured as health outcomes. More specifically, the study explores: 1) How financing of healthcare using domestic resources affects health outcomes. The effect of increased budgetary allocation to healthcare on health outcomes. And the effect of financial pooling and financial risk mitigation on the health systems’ equity. The concept of health production, based on Grossman’s (1972 & 2017) health capital theory, serves as the framework for empirical analysis of this work, using balanced panel data from 47 SSA countries, over 19 years. The dataset is pulled from relevant governments’ and multi-lateral organizations’ databases. Broadly, descriptive statistics and multivariate regression analysis are deployed in assessing the hypothesized relationships between the study’s relevant variables – financing of countries’ healthcare systems and various forms of health outcomes (i.e., life expectancy at birth, 5-year mortality rate, crude death mortality rate, and rate of infant mortality). The results indicate that financing healthcare using domestic public resources does relate insignificantly or negatively to health outcomes, but financing healthcare using domestic private resources relates significantly well with health outcomes. An increase in budgetary allocation to healthcare per capita relates beneficially to health outcomes. However, an increase in budgetary allocation as a percentage of total government expenditure affects the region’s health outcomes adversely; however, further tests of this relationship reveal that a reduction in indirect investment in healthcare could be responsible for the adverse effects. Thus, pointing to the need to balance the effects of the increase in both direct and indirect healthcare investments (expenditures). Lastly, apart from financial pooling using the private health insurance method, which affects health outcomes negatively, all the other pooling methods of healthcare financing affect the region’s health outcomes favorably. However, the social health insurance (SHI) effect on the region’s health outcomes is largely insignificant. Which may call into question its appropriateness as a vehicle for universal health coverage (UHC). The main conclusion of the study is that governments’ participation in healthcare financing is necessary for the SSA region’s health systems. However, increased government allocation should not be done at the expense of allocation to health-related activities (like the provision of clean water, sanitary services, etc.). We also found that domestic private healthcare funding methods associate favorably with health outcomes while domestic public healthcare funds do not. We argue that the reason for these confounding results is because of allocation problems, and recommend redistributive policies with a focus on the indigent and rural areas. Further diagnostic tests show that domestic public financing methods increase access to healthcare but not health outcomes. This shows that a financing method can increase access to healthcare but fail to improve population health status. Our findings also show that SSA health systems still need external financial assistance to be equitable. We recommend a gradual weaning from external assistance. On risk pooling, we recommend an increase in pool sizes and more accurate actuarial data to improve the performance of SHI and, to make it appropriate for UHC. Finally, governments of the SSA region should increase funding of healthcare by using public resources, ensure healthcare financing risk mitigation by increasing pool sizes of public financial pooling methods, and enact requisite legal and regulatory frameworks to guide the administration of private non-profit healthcare finance pooling schemes. Importantly, these governments should consider policies that correct for imbalances in the distribution of healthcare between the rich and the poor, and between rural and urban areas
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    Combining complexity leadership with operational systems and structures for adaptability in South African private hospitals
    (University of the Witwatersrand, Johannesburg, 2022) Nel, Karen
    The global healthcare landscape is complex. The South African Government and various other researchers have highlighted the unequal nature of the healthcare system in South Africa. The system is unsustainable and urgently needs substantial transformation in its current form. As set out by the South African Government, introducing universal healthcare coverage for the whole population is a solution. This will, however, significantly impact and change all role- players relatively quickly, especially for private hospitals. The purpose of this study was to critically examine whether private hospitals in South Africa were positioned for adaptability, considering complexity leadership (with concepts: entrepreneurial leadership, operational leadership and enabling leadership) and operational systems and structures (with concepts: agile, lean and leagile), as an approach to deal with the potential changes. A mixed methods study with an explanatory sequential design was utilised where the quantitative results and sample informed the population and questions of the qualitative study. Additionally, the quantitative results' drivers were identified in the qualitative study, namely causal factors, leadership and operational consequences, and aggravating factors. This study confirmed that the leadership displayed in private hospitals and the operational systems and structures implemented in private hospitals were not aligned with complexity leadership and operational systems and structures as defined in the conceptual model of this study. A unique finding was that operational systems and structures in private hospitals had a significantly higher impact on the hospitals' daily management than the leadership displayed in these hospitals. This was especially evident between managers and non-managers and between clinical and non-clinical employees, with non-clinical employees viewing the impact of the operational systems and structures implemented in hospitals as significantly more impactful than the leadership displayed in these hospitals. Furthermore, it was identified that operational leadership and lean systems and structures were the preferred approaches in private hospitals and negatively impacted the display of entrepreneurial leadership and agile systems and structures in these hospitals. Moreover, it was found that exploitative leadership, which is the leadership approach when dealing with old certainties, labelled as operational leadership in the current complexity leadership framework, should be relabelled a administrative-operational leadership in South African private hospitals, as a result of the hierarchical, autocratic culture. Assessing the impact of the COVID-19 pandemic on the leadership displayed and the operational systems and structures that were implemented in these hospitals, it was identified that employees can either experience disruption in a positive light through an adaptive response supported flexibility, or be traumatised by it when management implemented an order response with increased controls. It was conclusively confirmed that private hospitals in South Africa do not regularly display complexity leadership nor implement operational systems and structures as defined in this study's conceptual model. Four recommendations were made that can assist the private hospital industry in becoming more adaptable. The first recommendation is for the industry to implement CL and OSS as defined by the study's conceptual model. This implementation will naturally develop into an adaptive space. The second recommendation is to overcome the disconnect between industry players, head offices and hospitals, and to increase collaboration. Although the adaptive space will impact this recommendation positively, it has to be driven and supported by senior leadership. The third recommendation is to develop a formal industry framework for adaptability in private hospitals. The fourth recommendation is for the implementation of integrated and applied development programmes for leaders and staff at all levels. The programmes will assist everyone to better understand the relationship between CL, OSS, business acumen, and business success
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    The effect of smartwatches on patient-centered healthcare
    (University of the Witwatersrand, Johannesburg, 2022) Ndhlovu, Patson; Ndayizigamiye, Patrick
    Patient-centered healthcare lies at the core of health and social services, where individuals are recognized and encouraged to take an active role in their own care. The literature suggests that technological advancements are contributing to achieving patient-centred care. As technology is advancing, it is important to keep abreast of how emerging technologies are affecting patient-centred healthcare. Thus, the purpose of this study was to investigate the effects of smartwatches on patient-centred healthcare. To achieve this, this study assessed the effect of features of smartwatches on the Picker's 8 principles of patient-centred healthcare. The sample for this study was 141 participants who use smartwatches. These participants were all part of a running club based in Gauteng province of South Africa. The findings revealed that the activity tracking feature of a smartwatch has a moderate impact on emotional comfort and coordination and integration of care. Similarly, the vital signs monitoring feature has a moderate effect on the continuity and transition of care, while the data management feature demonstrated a moderate effect on the coordination and integration of care. Moreover, the activity tracking feature of a smartwatch has the strongest effect on the coordination and integration of care, while vital signs monitoring has the strongest effect on the continuity and transition of care. The data management feature, on the other hand, has the strongest effect on the coordination and integration of care. Findings from this study, albeit their limitations, can assist healthcare providers to make informed decisions on which features of smartwatches they should focus on when promoting the use of wearables to provide patient-centred car