Centralisation of financial decision-making on public hospitals in the Eastern Cape province
Background: The formal introduction of national health insurance in 2011 is making significant progress in South Africa. However, coronavirus disease 2019 (COVID-19) and the current financial situation pose a new challenge to South Africa’s ailing public health system, especially the centralisation...
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| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
AOSIS
2025-01-01
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| Series: | Africa’s Public Service Delivery & Performance Review |
| Subjects: | |
| Online Access: | https://apsdpr.org/index.php/apsdpr/article/view/827 |
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| Summary: | Background: The formal introduction of national health insurance in 2011 is making significant progress in South Africa. However, coronavirus disease 2019 (COVID-19) and the current financial situation pose a new challenge to South Africa’s ailing public health system, especially the centralisation of financial decision-making.
Aim: This article examines the implementation of centralisation of financial decision-making and its impact on the functioning of public hospitals to deliver public healthcare services.
Setting: The study’s research focussed on three public hospitals in the Eastern Cape province, South Africa.
Methods: This article followed the qualitative research method using semi-structured interviews and focus groups.
Results: Budget cuts, inadequate audit results, poor financial management and a lack of leadership support and management were the main reasons for centralising the financial decisions of public healthcare services to the Provincial Department of Health. The results further show that the chief executive offices in those hospitals do not have the power to make financial decisions, which affects hospital operations.
Conclusion: This article concludes that the centralisation of financial decision-making leads to delays in decision-making and poor public hospital functionality in delivering public healthcare services.
Contribution: It is crucial for public hospital leadership to understand which decision-making powers are centralised and which are decentralised. This understanding will assist public hospital leadership in assessing their respective hospitals’ specific needs and capabilities and strike a balance between the appropriate level of decentralisation, service performance, adequate staff availability and hospital functionality. Lastly, continuous monitoring and evaluation of the impact of centralised decision-making on public hospital operations could help public hospital leadership identify and promptly address any potential drawbacks. |
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| ISSN: | 2310-2195 2310-2152 |