The Academy of Science of South Africa (ASSAf) has released a consensus study report titled “Achieving Good Governance and Management in the South African Health System”. Conducted by a seven-member expert panel, explores the critical governance issues impacting the South African health sector and provides actionable recommendations for change.

Commissioned in September 2020, the consensus study panel, composed of professionals from various disciplines within the South African health system, embarked on an examination of the pillars underpinning good governance. The report highlights significant challenges, including leadership instability, lack of transparency, insufficient accountability mechanisms, and pervasive corruption.

Despite these obstacles, the study also acknowledges positive examples of effective governance, which serve as a foundation for the panel’s comprehensive recommendations aimed at systemic reform.

The report identifies several core areas of concern:

• Strategic Vision and Policy Design: the absence of a unified public value mission and inadequate delegation of authority impede effective governance.
• Transparency and Accountability: political interference and lack of transparent processes undermine accountability and trust in the health system.
• Participation and Consensus Orientation: limited community involvement and top-down management approaches restrict stakeholder engagement and decision-making.

The panel offers a roadmap for reform, emphasising the necessity of:

• Defining and communicating a clear public value vision.
• Updating legislation to insulate governance structures from vested interests.
• Delegating authority appropriately at all levels.
• Ensuring merit-based appointments and professionalising the civil service.
• Implementing fit-for-purpose systems to support managers and leaders.
• Fostering authentic community participation.
• Supporting managers at every level so that they have the resources, understanding and ability to build teams and attend to the relationships that make complex systems work, focusing on both the people within the health system (providers) as well those whom the health system serves.
• Acting decisively against corruption and protecting whistle-blowers.

Implementing these recommendations will require concerted effort from all stakeholders within the health system. The cost of inaction is great, potentially jeopardising the realisation of universal health coverage and the constitutional commitment to health care access and equality for all South Africans.

You can access the report here.