‘€œI think over and over again we have spoken about management. Management, management, management. Management is in place. But our management is ineffective. So, whether it’€™s now or when the NHI comes, if we have the same management, it’€™s not going to work. So, that must just be changed right now’€, said Dr Ziyanda Mgugudo, Vice-chairperson of the Junior Doctors’€™ Association of South Africa (JUDASA).

‘€œWe’€™re talking about everybody ‘€“ the superintendents, the CEOs, any type of manager you can think of in the hospital ‘€“ all the way down.   They do not understand what exactly we are trying to do within hospitals. And, as doctors, we’€™re getting more and more frustrated because it’€™s not getting better, instead it gets worse. We just need to make sure that people have got the correct qualifications for the job that they have been given’€, she added.

Echoing Dr Mgugudo’€™s sentiment, chairperson of JUDASA, Dr Mahlane Phalane, said hospital managers must have basic training in health. He described management in hospitals as ‘€˜mediocre’€™ and said ‘€˜it severely compromises competence with drastic consequences on health outcomes’€™.

‘€œWe have managers who are really blank when it comes to the issues of health. They come from elsewhere. They have been parachuted into the health care system for reasons only known by those who have done that act. We have situations where you have emergencies that in the medical field we understand need to be attended to within a certain period of time, but because of lack of understanding of the basic science of health, people who are supposed to make things move, like to arrange a chopper from a rural area in Mpumalanga to Pretoria for an emergency operation, may not understand that because that is a matter of health and death. Somebody with a health science background will understand that these are the kinds of things that are necessary. We have a situation where, for instance, we’€™ve got a high infant mortality rate. Some of the problems it’€™s just the issue of the incubators. We’€™ve got incubators that cannot regulate the temperature. The babies might even actually freeze to death. When you ask certain managers in the hospitals to say, ‘€˜get us incubators’€™, one actually went ahead and tried and procure an incinerator. This is not a joke. This is something that happened’€, he said.

Dr Phalane said the Health Department needs to review how it appoints hospital managers in preparation for the National Health Insurance scheme.

‘€œIf you have a health background you will understand what we mean when we say ‘€˜we need a particular equipment or instrument or medication’€™. There are certain basic life-saving medications that should never run out in our hospitals. If you have a basic health background you will understand that these kinds of things can make a difference between life and death.

We don’€™t want a situation where we don’€™t even have life-saving things like a drip, for instance. You may find that you only have got 200ml of drip, while you want one litre’€.

The NHI system will cost billions of rands to implement. Doctors are also concerned that the money will fall into the wrong hands and will not have the desired impact.

‘€œIf we’€™re just going to throw a lot of money ‘€“ whether it’€™s trillions of dollars or pounds – that does not mean an automatic improvement of our health care services. We need people who are going to use those funds prudently and who are going to prioritise because the problem here is you may find managers who prioritise the landscaping of a hospital. The hospital may look very good from the outside, but when you go inside the very basics are not there. We are saying you should go from inside outward, where you find that the funds that these managers control are used to actually make a direct impact on the patients who come into those hospitals, not for us to have posh chairs, not for us to have the best TVs in our hospital corridors. Those things don’€™t change the outcomes of health when those patients come. When patients come to hospital they won’€™t complain that they didn’€™t see a plasma screen. But they will complain that they didn’€™t get medication’€, said Dr Phalane.