Top hospital bosses may lose jobs

Nine of the 10 chief executives of the country's top hospitals will have to re-apply for their posts following a reclassification of the country's biggest hospitals.

These institutions, which have now been classified as central hospitals, will require chief executives to hold a post equivalent to that of a deputy director-general in the civil service.

They include King Edward VIII and Nkosi Albert Luthuli in Durban, Groote Schuur and Tygerberg in Cape Town, Chris Hani Baragwanath, Charlotte Maxeke, Steve Biko and George Mukhari in Gauteng, Nelson Mandela in Mthatha, and Universitas in Bloemfontein.

Details of the new designation of hospitals into district, regional, tertiary, central and specialist - in preparation for National Health Insurance (NHI) - were gazetted on Friday.

According to the gazette, a central hospital renders a very high and specialised service on a national basis and is a platform for the training of health workers. It also functions as a highly specialised referral unit for other hospitals.

Currently, only one of the chief executives, according to Minister of Health Aaron Motsoaledi, is at the level of a deputy-director general.

The minimum qualifications, experience and generic qualities for appointment as a chief executive are expected to be provided in regulations that are being developed.

According to the gazette, a degree or advanced diploma in a health-related field is a prerequisite for appointment as a chief executive, and a degree or diploma in management will be an added advantage.

A minimum of five years' management experience in the health sector is also essential.

But even chief executives of small district hospitals that have between 50 and 150 beds, will now have to be registered health professionals.

The gazette stated it would be an "absolute waste of resources" to have both a chief executive and a clinical manager based at a small district hospital and that a chief executive should serve as both.

Motsoaledi yesterday confirmed that the nine chief executives would have to re-apply for their posts.

"The job will be advertised, and that person is entitled to be interviewed. The intention is not to retrench anybody and say, 'There's a new dispensation, you must go,' because there's always an available level for them within the public service which is appropriate for their skills."

An investigation by the Development Bank of Southern Africa, commissioned by the Department of Health, found that 2% of chief executives at hospitals had only a matric and that fewer than three-quarters had a health qualification as their highest qualification.

According to the report, 10% had a business degree and 8% a public administration degree. At least 82% were above the age of 46, while 37% were older than 56.

Motsoaledi, who held a workshop with his MECs yesterday on the new NHI, which was unveiled this week, said he had asked the eight medical schools to increase their student intake.

"Wits responded by taking in an extra 40 students this year, and the others said they will do it from next year."

He said the number of medical students sent to train in Cuba had been increased to 80 and a new medical school would be built in Limpopo.

He also confirmed that his department would continue recruiting foreign doctors, adding that it would be done within international protocols.

"It (the NHI) is historic. We are taking a giant leap to say, 'Now let's implement.' For the past eight years, there's been many commissions on how to deal with healthcare and all of them gave one recommendation: that we need a form of health insurance."

The 10 districts earmarked for the piloting of the NHI had not yet been identified because an audit of the country's 4200 healthcare facilities was still under way. "We have just completed 800 and, by February, we would have completed 94% of hospitals."

Olive Shisana, chairman of the ministerial advisory committee on the development of the NHI, said that the audit involved checking whether infection control was being conducted in a way that made the patient feel safe.

"It's checking to make sure whether the patient is satisfied with the services provided and whether drugs that should be there are there," said Shisana.

She said that finding out whether those in management had the skills to manage also formed part of the audit.