An analysis of the human resource management function during the decentralisation of Hospital management: case of North West Province

Mothoagae, Mogale Phillemon
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Background: The National Department of Health adopted decentralisation of hospital management as a key policy in pursuit of a more efficient, effective, responsive and accountable public sector hospital system. The proposed decentralisation of hospital management represented a fundamental policy shift in the decision making processes between National, Provincial health departments and Hospitals. Provincial health departments were to “delegate significant decision making powers to hospital managers, including the authority to make decisions relating to personnel, procurement, and financial management” Objective: To gain in-depth understanding of the decentralisation of hospital management processes between 1996 and 2007 as it relates to the Human Resource Management function in public hospitals. Methodology: The study design was a descriptive qualitative comparative case study design. Results: Decentralisation was promoted as a policy reform to improve efficiency, equity and effectiveness of hospitals in South Africa. There was no formal policy from the National Department of Health guiding the implementation of decentralisation of hospital management. There was a shift of power over the control of HRM function between 1996 and 2007. Regional hospital gained more space and had more wide range of choices allowed in almost all HRM activities. District Hospital has gained some space and now has moderate choice allowed. The experiences and understanding of health managers vary on what happened during the policy process. Conclusion: The study found conclusive evidence that there are changes to HRM function during the ongoing debate on decentralisation of hospital management. More HRM functions were delegated to Hospitals.