Health management

2008-11-17 00:00

Briefing the press on how it contrived to run up some R2,7 billion in over-expenditure, the KwaZulu-Natal Health Department has acknowledged that while there are factors beyond its control, the main reason is the lack of skilled management. Indeed, while the national government has put all the provincial health departments into the red by introducing the Occupational Specific Dispensation (OSD) without providing adequate funding, poor management is the only possible explanation for such massive overspending.

It is perhaps encouraging that Health MEC Peggy Nkonyeni has worked with the provincial Treasury to devise a rescue plan. By and large, however, this amounts to little more than a tightening up on things that should be properly controlled in the normal course of events, and that certainly should have been recognised and checked at a much earlier stage — ghost employees, overpayments, poor supply chain and contract controls, inflated overtime pay and subsistence and travel claims, and fraudulent practices with regard to medicines. And, good as it is that specific problem areas have now been identified, listing them is one thing, correcting them quite another. When things go wrong, the public sector has a distinct tendency to assemble think-tanks or call in consultants (often at considerable cost), but not to take any really effective action on whatever report emerges — beyond, perhaps, declining to publish it.

Talking about things is not the same as doing them, and, as this instance again illustrates, effective management is essential. The simple routine practice, common in the business sector, of calling in monthly reports that compare expenditure with budget and then holding employees accountable for any discrepancies would surely have prevented the build-up of this massive year-end figure. And effective management, in turn, is basically a matter of putting the right people into the right jobs. Let it be hoped that the scale of this fiasco will bring forward the time when competence, and not race or political and family connections, is the criterion for appointments.

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