Challenges

Lack of Medical products, vaccines and technology

In the current situation, Stakeholders felt that the challenges related to medical devices, vaccines
and technology relate particularly to lack of access and affordability, procurement, storage and
distribution. Patients who visited public health facilities considered the unavailability of staff, drugs,
and equipment to perform the diagnosis as a sign of lack of access to services. Procurement of
medicines was centralized with the state government through transaction accounts managed by
medical supply stores on behalf of all state hospitals and clinics. Needs assessments for medical
products, drugs, and medical devices were conducted at surrounding facilities by site-based
procurement personnel. Officials documented the requirements in the Requirements and
Procurement Plan for further processing by state health departments. The biggest challenge with
some life-saving drugs has been that almost all of them are under
contracts reviewed by national health agencies.

states are not permitted to procure outside of these agreements. For federal states to deviate from
this system, they must first seek permission from state health authorities. In particular, permits were
sometimes granted when drug shortages were imminent because government-appointed suppliers
failed to supply and deliver ordered drugs or drugs. Centralized procurement is considered a
strength of the country's medicines, but inefficiencies in supplier services lead to inefficiencies and
inadequate delivery of healthcare services, medicines and other medical devices. , is exacerbated by
the lack of adequate pharmaceutical staff and ICT systems.

Financing

Challenges identified by stakeholders in underfunding, rising costs, economic sustainability, and lack
of economic autonomy in the current health system. The State Treasury allocates appropriate
percentages to health services based on state government priorities. Health now ranks him second
after education. The use of financial incentives requires careful planning and management to avoid
demoralizing staff. OSD was introduced in South Africa with the aim of increasing health worker
retention in remote and rural areas through improved
counts. However, stakeholders in current assessments often report unintended negative
consequences, such as poor planning to budget overruns, unmet expectations of doctors and nurses,
inequality in amounts received, perceptions of injustice, dissatisfaction and division. results suggest
a number of problems with OSD policy enforcement. Across various categories of public service
providers.

Factors believed to cause underallocation of financial resources to meet the operational needs of
the health system include high costs of OSDs, RWOPS, office rents, medicines, and other
consumables. In particular, by enabling RWOPS to be implemented for both health professionals and
related professions, it can be used against fixed salary payments and non-payment of benefits if
abused due to inadequate managerial oversight. We had a big staff shortage. RWOPS is a system
created by the Public Services Act 1994, Chapter VII, Section 30 [63]. This section authorizes
departmental political leaders to allow eligible employees to engage in paid employment outside of
their regular employment. Therefore, civil servant doctors, nurses, and other professionals can also
work in the private sector outside of normal working hours. But this situation has been exploited for
poor and cumbersome oversight, which has led to understaffing, truancy, and abuse of public service
agencies in order to seek additional compensation from professionals.
Poor Leadership and governance

In the current assessment, stakeholders felt that poor leadership and governance of the Free State
public health department had a negative impact on service delivery. This was considered equivalent
to the 'risk to patient care' mentioned in 38 of the 44 reports. This perception was exacerbated by
cases in which patients reported finding staff behavior unacceptable and even patients requiring
urgent care were sometimes ignored. Health system governance (or stewardship) is a complex but
important component of any health system.

Governance functions are critical to the equitable delivery of health services throughout the public
health system. Yet leadership and governance are among the most difficult functions of the
healthcare system to define, measure and monitor. This is tricky because without adequate
investment in health system governance and stewardship, the returns from investing in public health
service delivery are unlikely to sustain over the long term.

Citing Management Sciences for Health, Gilson and Daire emphasized that South African health
managers must always be 'lead managers'. These authors argued that there are two main reasons
why health system governance is important. The first is the policy implementation challenge and the
second is related to organizational structure and culture. Centralized decision-making has failed in
free states without delegating DHS delegations to districts and institutions.

In the Free State, centralised decision-making without devolution of delegations of the DHS failed to
provide the district and facility managers with the means to lead and manage. The situation
appraisal observed that stakeholders believed that where there was weak leadership and poor
governance n the presence of good policies but poor implementation, unsatisfactory priority setting
and lack of governance structures to ensure accountability, the risk to patient care increased and
provision of quality health service was compromised.

Despite political commitment, strong policies and sound regulations since 1994, the public health
sector in South Africa and the Free State has not yielded desired health system performance due
mainly to fragmentation and weak and poor leadership at the district, regional and tertiary levels of
care which are the implementation levels for health system reform to improve system performance .

Lack of service integration due to fragmentation of system operations and poor policy coordination
exacerbates verticalization, fosters a “single” mentality, and bypasses existing policies and
procedures to undermine health system performance.Stakeholders considered this to be an
important factor contributing to worsening disease and treatment outcomes. Several HR issues and
poor leadership and governance have emerged as major causes of poor public health service
delivery in South Africa.