Hospital management and health policy—a South African perspective

It is 25 years since the advent of democracy in South Africa. From the start the priority was to deal with the inequity that was the hallmark of the apartheid regime. In 1994, the Government’s Reconstruction and Development Programme set out broad principles and strategies for development in all sectors to deal with the lack of services experienced by the majority of South Africans. The rights-based Constitution contains the Bill of Rights that obliges the government to ensure the rights of all citizens to have access to healthcare services. Multiple policy documents, directives and guidance have been issued by the National Department of Health but there remains a gap between policy and practice. The White Paper, Transformation of the Health System in South Africa, released in 1997 stated that the three spheres of government, NGOs and the private sector would unite in the promotion of common goals. With the preparation underway to implement a National Health Insurance Scheme the need for unity in the system has never been greater. A key challenge is the difference in the approach to management and to a large extent the difference in the calibre of management in the public and private sectors. Much has been achieved but much remains to be done to ensure a high-quality health system for all citizens.