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 Health  Vol.8 No.12 , September 2016
The Social Determinants of Health and the Role of the Health Care System: A Case Study of the Significance of Good Governance in Public Hospitals in South Africa
Abstract: Increasingly international and national policies are being directed at actions for the social determinants of health and for an integrated approach to health care provision, not only in terms of institutional cooperation but also stakeholder involvement. A key component of both these policies is the development of good governance principles in all health care agencies and organizations. A neglected dimension in these debates has been the role of the public hospital which remains a vital and expensive dimension of service provision. In a case study of a public hospital in South Africa, this paper charts the readiness of its management principles and activities to provide quality health care linked to population health and to contribute to the non-medical determinant of health. Using Taylor’s principles of good governance, we conclude that there is a mixture of good and not so good governance activity. The paper concludes by examining the external constraints on the public hospital and by providing suggestions for future activities.
Cite this paper: Fusheini, A. , Eyles, J. and Goudge, J. (2016) The Social Determinants of Health and the Role of the Health Care System: A Case Study of the Significance of Good Governance in Public Hospitals in South Africa. Health, 8, 1288-1306. doi: 10.4236/health.2016.812131.
References

[1]   Keeton, G. (2014) Inequality in South Africa. Helen Suzman Foundation, 1, 26-31.

[2]   Benatar, S. (2013) The Challenges of Health Disparities in South Africa. SAMJ: South African Medical Journal, 103, 154-155.
http://dx.doi.org/10.7196/SAMJ.6622

[3]   Ataguba, J.E., Akazili, J. and McIntyre, D. (2011) Socioeconomic-Related Health Inequality in South Africa: Evidence from General Household Surveys. International Journal for Equity in Health, 10, 48.
http://dx.doi.org/10.1186/1475-9276-10-48

[4]   Moller, V. (2013) South African Quality of Life Trends over Three Decades, 1980-2010. Social Indicators Research, 113, 915-940.
http://dx.doi.org/10.1007/s11205-012-0120-y

[5]   Ataguba, J.E.-O., Day, C. and McIntyre, D. (2015) Explaining the Role of the Social Determinants of Health on Health Inequality in South Africa. Global Health Action, 8, Article ID: 28865.
http://dx.doi.org/10.3402/gha.v8.28865

[6]   Halfon, N., Larson, K. and Russ, S. (2010) Why Social Determinants? Healthcare Quarterly, 14, 8.

[7]   Wilkinson, R.G. and Marmot, M.G. (2003) Social Determinants of Health: The Solid Facts: World Health Organization.

[8]   NCCAH (2011) Access to Health Services as a Social Determinant of First Nations, INUIT and MéTIS Health.

[9]   Tucker-Seeley, R.D., Mitchell, J.A., Shires, D. and Modlin Jr., C.S. (2015) Financial Hardship, Unmet Medical Need, and Health Self-Efficacy among African American Men. Health Education & Behavior, 42, 285.
http://dx.doi.org/10.1177/1090198114557125

[10]   Bozorgmehr, K. and Razum, O. (2015) Effect of Restricting Access to Health Care on Health Expenditures among Asylum-Seekers and Refugees: A Quasi-Experimental Study in Germany, 1994-2013. PLoS One, 10, e0131483.
http://dx.doi.org/10.1371/journal.pone.0131483

[11]   Coovadia, H., Jewkes, R., Barron, P., Sanders, D. and McIntyre, D. (2009) The Health and Health System of South Africa: Historical Roots of Current Public Health Challenges. The Lancet, 374, 817-834.
http://dx.doi.org/10.1016/S0140-6736(09)60951-X

[12]   South Africa (2012) Health Care in South Africa.
http://www.southafrica.info/about/health/health.htm#.V645mv5o3IV

[13]   SAHRC (2009) Public Inquiry: Access to Health Care Services. A Report and Recommendations Based on the Submissions and Proceedings of Public Hearings Conducted at the National Office of the South African Human Rights Commission, Parktown, Johannesburg from 30 May to 1 June 2007.

[14]   Day, C. and Gray, A. (2015) Health and Related Indicators. South African Health Review, 15, 198-332.

[15]   Republic of Africa (2015) Minister Aaron Motsoaledi: Health Dept Budget Vote 2015/16.
http://www.gov.za/speeches/minister-aaron-motsoaledi-health-dept-budget-vote-201516-5-may-2015-0000

[16]   Greiner, A.C. and Knebel, E. (2003) Health Professions Education: A Bridge to Quality. National Academies Press, Washington DC.

[17]   Slipicevic, O. and Masic, I. (2012) Management Knowledge and Skills Required in the Health Care System of the Federation Bosnia and Herzegovina. Materia Socio Medica, 24, 106-111.
http://dx.doi.org/10.5455/msm.2012.24.106-111

[18]   Pillay, R. (2008) Managerial Competetncies of Hospital Managers in South Africa: A Survey of Managers in the Public and Private Sectors. Human Resources for Health, 6, 4.
http://dx.doi.org/10.1186/1478-4491-6-4

[19]   Von Holdt, K. (2010) Nationalism, Bureaucracy and the Developmental State: The South African Case. South African Review of Sociology, 41, 4-27.
http://dx.doi.org/10.1080/21528581003676010

[20]   Von Holdt, K. and Maserumule, B. (2005) After Apartheid: Decay or Reconstruction? Transition in a Public Hospital. In: Webster, E. and Von Holdt, K., Eds., Beyond the Apartheid Workplace: Studies in Transition, University of KwaZulu-Natal Press, Scottsville.

[21]   Von Holdt, K. and Murphy, M. (2007) Public Hospitals in South Africa: Stressed Institutions, Disempowered Management. In: Buhlungu, S., Daniel, J., Southall, R. and Lutchman, J., Eds., State of the Nation: South Africa 2007, HSRC Press, Cape Town, 312-341.

[22]   Schneider, H., Barren, P. and Fonn, S. (2007) The Promise and the Practice of Transformation in South Africa’s Health System. In: Buhlungu, S., Daniel, J., Southall, R. and Lutchman, J., Eds., State of the Nation: South Africa 2007, HSRC Press, Cape Town, 289.

[23]   Burnett, S., Mendel, P., Nunes, F., Wiig, S., van den Bovenkamp, H., Karltun, A., et al. (2016) Using Institutional Theory to Analyse Hospital Responses to External Demands for Finance and Quality in Five European Countries. Journal of Health Services Research & Policy, 21, 109-117.
http://dx.doi.org/10.1177/1355819615622655

[24]   DoH (2015) National Health Insurance for South Africa: Towards Universal Health Coverage. Department of Health, Pretoria.

[25]   NPC (2012) National Development Plan 2030: Our Future—Make It Work.

[26]   Visser, R., Bhana, R. and Monticelli, F. (2012) The National Health Care Facilities Baseline Audit National Summary Report. HST, Durban.

[27]   E-Health News (2011) DBSA Report on Hospital CEOs.

[28]   OBG (2016) Reforms and a New Strategy Aim to Improve South Africa’s Health Sector. Oxford Business Group, Oxford.
http://www.oxfordbusinessgroup.com/overview/what-doctor-ordered-recent-improvements-and-new-strategy-provide-strong-foundation-future-growth

[29]   Bateman, C. (2013) Hope at Last for Crisis-Ridden Gauteng Academic Hospitals? South African Medical Journal, 103, 705-706.
http://dx.doi.org/10.7196/SAMJ.7469

[30]   Bateman, C. (2013) Health Leadership Training Academy Tackles Worst First. South African Medical Journal, 103, 707-708.
http://dx.doi.org/10.7196/SAMJ.7480

[31]   Padarath, A. and English, R. (2011) South African Health Review 2011. Health Systems Trust, Durban.

[32]   CIHI (2014) Measuring the Level and Determinants of Health System Efficiency in Canada.

[33]   Hadad, S., Hadad, Y. and Simon-Tuval, T. (2013) Determinants of Healthcare System’s Efficiency in OECD Countries. The European Journal of Health Economics, 14, 253-265.
http://dx.doi.org/10.1007/s10198-011-0366-3

[34]   NysHealth (2016) The Role of Hospitals in Improving Non-Medical Determinants of Community Population Health.

[35]   WHO (2016) Social Determinants of Health. WHO.
http://www.who.int/social_determinants/en/

[36]   Kickbusch, I. and Gleicher, D. (2012) Governance for Health in the 21st Century. World Health Organization, Geneva.

[37]   Brandao, C., Rego, G., Duarte, I. and Nunes, R. (2013) Social Responsibility: A New Paradigm of Hospital Governance? Health Care Analysis, 21, 390-402.
http://dx.doi.org/10.1007/s10728-012-0206-3

[38]   Hiatt, H.H. (1975) Protecting the Medical Commons: Who Is Responsible? New England Journal of Medicine, 293, 235-241.
http://dx.doi.org/10.1056/NEJM197507312930506

[39]   Brinkerhoff, D.W. and Bossert, T.J. (2014) Health Governance: Principal-Agent Linkages and Health System Strengthening. Health Policy and Planning, 29, 685-693.
http://dx.doi.org/10.1093/heapol/czs132

[40]   Durán, A., Saltman, R.B. and Dubois, H.F. (2011) A Framework for Assessing Hospital Governance. In: Governing Public Hospitals, WHO, Copenhagen, 35-53.

[41]   Ditzel, E., Strach, P. and Pirozek, P. (2006) An Inquiry into Good Hospital Governance: A New Zealand-Czech Comparison. Health Research Policy and Systems, 4, 2.
http://dx.doi.org/10.1186/1478-4505-4-2

[42]   Eeckloo, K., Van Herck, G., Van Hulle, C. and Vleugels, A. (2004) From Corporate Governance to Hospital Governance. Authority, Transparency and Accountability of Belgian Non-Profit Hospitals’ Board and Management. Health Policy, 68, 1-15.
http://dx.doi.org/10.1016/j.healthpol.2003.07.009

[43]   NDoH (2012) National Health Act, 2003: Policy on the Management of Hospitals. Government Gazette, Department of Health, Pretoria.

[44]   Jakab, M., Preker, A.S. and Harding, A. (2003) The Missing Link? Hospital Reform in Transition Economies. In: Harding, A.L. and Preker, A.S., Eds., Innovations in Health Service Delivery: The Corporatization of Public Hospitals, Health, Nutrition, and Population, World Bank, Washington DC, 207-238.

[45]   Taylor, W.D. (2000) Facts, Myths and Monsters: Understanding the Principles of Good Governance. International Journal of Public Sector Management, 13, 108-124.
http://dx.doi.org/10.1108/09513550010338755

[46]   Aseweh Abor, P., Abekah-Nkrumah, G. and Abor, J. (2008) An Examination of Hospital Governance in Ghana. Leadership in Health Services, 21, 47-60.
http://dx.doi.org/10.1108/17511870810845905

[47]   Botje, D., Klazinga, N.S. and Wagner, C. (2013) To What Degree Is the Governance of Dutch Hospitals Orientated towards Quality in Care? Does This Really Affect Performance? Health Policy, 113, 134-141.
http://dx.doi.org/10.1016/j.healthpol.2013.07.015

[48]   Alves Ad, S.D. (2011) Responsabilidade e governacao na moderna gestco hospitalar.

[49]   Indahwaty, A. and Sudirman, I. (2014) A Conceptual Model of Indonesia Hospital Accountability in Hospital Reformation Era.

[50]   Ensor, T., Kruger, J. and Lievens, T. (2009) Improved Methods for Funding Public Hospitals in South Africa.

[51]   Yin, R.K. (1999) Enhancing the Quality of Case Studies in Health Services Research. Health Services Research, 34, 1209-1224.

[52]   Patton, M.Q. (1990) Qualitative Evaluation and Research Methods. Sage Publications Inc., Thousand Oaks.

[53]   Creswell, J.W. (2007) Qualitative Enquiry and Research Design: Choosing among Five Approaches. Sage Publications Inc., Thousand Oaks.

[54]   Undheim, T.A. (2003) Getting Connected: How Sociologists Can Access the High Tech Elite. The Qualitative Report, 8, 104-128.

[55]   Massyn, N., Day, C., Peer, N., Padarath, A., Barron, P. and English, R. (2014) The District Health Barometer: Year 2013/14. Health Systems Trust, Durban.

[56]   McCracken, G. (1988) The Long Interview. Vol. 13, Sage Publications Inc., Thousand Oaks.
http://dx.doi.org/10.4135/9781412986229

[57]   Lee, S.Y.D., Alexander, J.A., Wang, V., Margolin, F.S. and Combes, J.R. (2008) An Empirical Taxonomy of Hospital Governing Board Roles. Health Services Research, 43, 1223-1243.
http://dx.doi.org/10.1111/j.1475-6773.2008.00835.x

[58]   Von Holdt, K. and Murphy, M. (2007) Public Hospitals in South Africa: Stressed Institutions, Disempowered Management. In: Buhlungu, S., Daniel, J., Southall, R. and Lutchman, J., Eds., State of the Nation: South Africa 2007, HSRC Press, Cape Town, 312-341.

 
 
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