Chief executive officers and public hospital management in South Africa

Thesis (Ph.D.)--University of the Witwatersrand, Faculty of Commerce, Law and Management, Wits School of Governance, 2016CEOs of public hospitals in South Africa are often held responsible when their institutions fail to deliver good quality care and are associated with poor health outcomes. Negative perceptions prevail and particularly in the National Department of Health it is held that the CEOs are generally not adequately qualified, inexperienced, incompetent and often inappropriately appointed. This study attempts to articulate the CEOs views (their side of the story) and in particular how they perceive the challenges that they face and what solutions they proffer in improving the running of their institutions. This research is viewed through the lens of the New Public Management paradigm (NPM), in terms of Public Sector Reform and in particular Health Sector Reform in South Africa. Thirty CEOs of public hospitals in South Africa responded to a survey of their opinions. The majority (86%) of them felt they were unable to manage their institutions effectively. A subsequent qualitative study of CEOs and experts in public management using in depth interviews and further focus group discussions with CEOs and senior hospital managers revealed that the major challenges that the CEOs faced were financial, human resources and operational management issues. Procurement and information challenges were linked to financial and human resources deficiencies, lack of accountability mechanisms and the presence of corruption. The Performance Management System currently in place did not work appropriately and was driven by perverse incentives. Political interference was also a pervasive problem. Their recommendations were that they needed clear and unambiguous delegations and the appropriate resources so that they can take full responsibility of their institutions. Clear accountability structures were paramount in achieving better health service management and care according to the advice of experts in public management as well as that of senior hospital managers. This requires the creation of enabling legislation and an appropriate accountability framework. The blanket application of NPM principles is also questioned. Selective application of the tools of NPM should be tested and consideration be given to the dimension of added public value in the South African public hospital context.GR201

Consent for children participating in research

This letter is in response to a SAMJ article and correspondence indicating the non-legal requirements for parental consent for research on children. Reply by C Slack, A Strode and Z Essack

Allergic reactions and anaphylaxis during anaesthesia

Although allergic reactions during anaesthesia are rare, it may have potentially life threatening consequences when anaphylaxis develops. Should a patient have a possible reaction under anaesthesia, it is important to identify an offending agent to prevent re-exposure during subsequent procedures. This review aims to identify common causes of anaphylaxis during anaesthesia, how to deal with the emergency, and how to follow up the at-risk patient.http://www.allergysa.org/journal.htmhb201

Asymmetrical soft palate cleft repair : preliminary results

The reconstructions of the asymmetrical soft palate cleft is a surgical challenge when it comes to achieving symmetry and optimal soft palate muscular function. Three different versions of the intravelar veloplasty have been used: the intravelar veloplasty (1969) (type I), the modification according to anatomical defects (1991) (type II), and the modification using part of Sommerlad’s technique and part of Ivanov’s technique (2008) (type III). The perioperative outcomes of the type II and type III intravelar veloplasty were assessed and compared in asymmetrical cleft cases. Two hundred and seventy-seven soft palate clefts were reconstructed: 153 type II and 124 type III. Of these, 49 were asymmetrical (17.7%); 23 underwent the type II procedure and 26 the type III procedure. Of the type II procedure cases, 30.4% remained asymmetrical postoperatively compared to 3.8%of the type III cases. The uvula appeared subjectively atrophic in 47.8% of the type II cases and in 7.7% of type III cases. Oro-nasal fistula occurred in 13.0% of the type II cases and 3.8% of the type III cases. Speech results will only be assessed after 4 years of age. The type III modified intravelar veloplasty has had a major beneficial impact on patients who had an asymmetrical soft palate cleft.http://www.sciencedirect.com/science/journal/09015027hb201

Mental health leadership and patient access to care: a public–private initiative in South Africa

BACKGROUND: Mental health leadership is a critical component of patient access to care. More specifically, the ability of mental health professionals to articulate the needs of patients, formulate strategies and engage meaningfully at the appropriate level in pursuit of resources. This is not a skill set routinely taught to mental health professionals. METHODS: A public-private mental health leadership initiative, emanating from a patient access to care programme, was developed with the aim of building leadership capacity within the South African public mental health sector. The express aim was to equip health care professionals with the requisite skills to more effectively advocate for their patients. The initiative involved participants from various sites within South Africa. Inclusion was based on the proposal of an ongoing "project", i.e. a clinician-initiated service development with a multidisciplinary focus. The projects were varied in nature but all involved identification of and a plan for addressing an aspect of the participants' daily professional work which negatively impacted on patient care due to unmet needs. Six such projects were included and involved 15 participants, comprising personnel from psychiatry, psychology, occupational therapy and nursing. Each project group was formally mentored as part of the initiative, with mentors being senior professionals with expertise in psychiatry, public health and nursing. The programme design thus provided a unique practical dimension in which skills and learnings were applied to the projects with numerous and diverse outcomes. RESULTS: Benefits were noted by participants but extended beyond the individuals to the health institutions in which they worked and the patients that they served. Participants acquired both the skills and the confidence which enabled them to sustain the changes that they themselves had initiated in their institutions. The initiative gave impetus to the inclusion of public mental health as part of the curriculum for specialist training. CONCLUSIONS: Despite the significant adverse social and economic costs of mental illness, psychiatric and related services receive a low level of priority within the health care system. Ensuring that mental health receives the recognition and the resources it deserves requires that mental health care professionals become effective advocates through mental health leadership

Strong positive growth responses to salinity by Ceriops tagal, a commonly occurring mangrove of the Gujarat coast of India

Ceriops tagal commonly occurs along the Gujarat coast of India. It has evolved a high degree of salinity tolerance and optimal growth occurs at 12.6 ppt. This is related to an adaptive regulation of hydration and ionic content