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The public health system is only as strong as its workers

19 March 2013, 15:00

The year 2011 ushered in a public health revolution in Gauteng. Melding a vision of health improvement and community empowerment, the Department of Health in Gauteng heeded the growing call for improved public health service delivery.

Reading media reports and leaked statements there seemed to be undertones that suggested that the Department was “overtaken by madness” and instead of transforming the public health system it was on a course to destruction. The public health system was viewed as a “cousin” to health care.

Was this a call for a turning point? Was a turning point necessary? Absolutely!

Premier N Mokonyane, MEC AHM Papo and the leadership in the health department designed an initiative to build a public health - which was a  drastic change process - that ensures the conditions that led to the institution of section 100 (1) (b) are addressed. This period marked a turning point which embraced the concept of collaborative partnership amongst the key stakeholders in the delivery chain of public healthcare in Gauteng. The ultimate vision is a public health system responsive to the needs of its communities, devoting resources to areas that can best improve population health for the realisation of Vision 2055.

Over the past years health systems in Gauteng declined sharply. Even with the comparative advantages on our side, the health of the population began lagging behind some of the other Provinces. The challenges of addressing deep-rooted problems seemed huge. For many in management, “it was like being thrown into the deep end". Many senior managers left the Department and those who came in had nothing to go on.

But, the history of South Africa's public health is based on a vision of people who are healthy, not just because of access to appropriate medical services, but also because of neighbourhood vitality, satisfying employment, safe environments, and diverse recreational,  educational, and cultural opportunities.

However; the entire field of public health had started to face huge challenges, e.g. the quadruple burden of disease. The citizen's health needs are growing. Public health issues are becoming more complex. Yet many in the cold face of healthcare delivery are losing patience and others have realized they neither can nor want to shoulder the burdens of leadership alone.

The public health system is only as strong as its workers!

When the Gauteng Department of Health decided to be proactive in creating change, it called for a  broad-based partnership and developed a comprehensive turnaround strategy. As anyone who has been in the Gauteng Provincial Administration would know; when Gauteng wants something, the entire Province is expected to get behind the effort. This time the goal was to gain lasting support for public health. A new era had  begun.

When government first set out to improve its public health system; the focus was initially systemic. But it soon became clearer that citizens need to recognize the value and role of the public health system, community by community. Together,  building a healthier Gauteng, brick by brick.

Since the adoption and implementation of the turnaround strategy it became clear that no single set of steps will bring about a better public health system. The mystery and beauty behind this change, however, is that it can originate just about anywhere. And, when the opportunity for change comes knocking, luck favours the prepared mind.

The challenge now is to build a facility level capacity to recognize common interests, especially the capacity to recognize and understand other perspectives.  This requires a continued effort of building a new paradigm of leadership that includes collaboration and collaborative leadership. We know that not every public health worker comes to the Department with a correct set of mind. Therefore, there is a need to develop a new mindset with new values and principles where everyone can, over time, both define and build the skill sets necessary to change the way the department functions. This will eventually create a collaborative leadership knowledge base that is part and parcel of the mainstream.

The Department also needs people with a commitment to the change process, a way of doing things. And this often refers to helping people develop the confidence to take action and sustain their energies through difficult times.

People in the delivery of public health must understand that they share a common responsibility to bring out the best in people around them. Confident people can commit to an action and not have to ask everyone around them. People must also create opportunities to reflect on, understand the implications and results of various actions they take.

Healthcare workers are also a lot more alike than they are different. There is a need to recognize the importance of proactively developing a web or network of interconnectedness and to allow these relationships to accomplish well beyond the initial collaboration.

The leadership in the Gauteng Department of Health on the other hand is committed to;

a)       ensuring that people are involved in the process of change, no matter in some small scale,

b)       All those in the cold face of delivery must be able to experience the change and see the benefits for themselves,

c)       Help people identify the common values that will drive the work long term and also provide the “glue” to be successful over time,

d)       Do the “under-the-radar” work of building relationships and the champions that will help move the work forward,

e)       Build the support and infrastructure that enables those with special skills or knowledge to apply those skills as participants in a collaborative process toward improving health outcomes,

f)         And, to understand what the “skeptics” care about, identify their interests and provide ways to show how the collaborative process is likely to ultimately support their interests as well.

CHRIS MAXON is a public servant in the Gauteng Department of Health and a government communicator.

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