A Review of Health Management Training in the Public Health Sector in South Africa

Over the past five years through the work of foreign development agencies and a series of national seminars and workshops the principles and components of a nationally co-ordinated strategy for health management training has been formulated. In 1995 this strategy was transformed into a National Management Development Framework which has served as a guide to the Department of Health in commissioning training and development programmes for health service managers, and in creating a supportive environment for management development.

In order to support the development of a more co-ordinated approach to health management training in the public health sector, the Public Health Programme of the University of the Western Cape was requested by the Health Systems Trust to conduct an audit of the health management training programs that have been implemented over the past 4 years in this sector. Information about Diploma- and Certificate-level health management training programmes that are currently being offered by educational institutions and agencies within South Africa was also documented within the review.

In compiling the audit, the researchers received assistance from personnel in the Human Resource Development and Training Sections in the Provincial Health and/or Welfare Departments.

The review revealed that over the past four years there has been a growing awareness of the need to develop a new approach to management training throughout the country both within the health department and within various training institutions. In addition, the number of personnel undergoing management training has increased significantly.

The manner in which provincial Human Resource Development and/or Training Directorates have chosen to develop their management capacity appears to have varied between the provinces: in some provinces the choice has been made to use one training programme to train a significant number of health personnel (or district health teams) across the province (for example in the Northern Cape and in the Free State). In other provinces (such as the Northern Province) training programmes have been designed specifically for the different categories of management within the health and welfare department. In provinces which have a considerable wealth of training resources within their immediate environment, personnel have been placed on existing health management training courses (for example in the Western Cape and Gauteng Provinces).

Generally, however, it appears that provinces have been making use of a combination of training programmes from the more formal diploma or certificate level courses to the shorter once-off workshops run at a district or institutional level.

In reviewing the data, a number of positive trends could be seen to be emerging in the field:
Firstly, the concept of training health management teams is an approach which is strongly supported by most of the provinces. In-service, problem-based training at a sub-district and district level is emerging as a significant and complementary initiative to this approach in certain provinces.

Secondly, the establishment of partnerships between the provincial health department and a number of academic and/or training institutions in developing, facilitating and supporting health management training is a developing practice in particular provinces.

Thirdly, there is a perceptible shift in the type of training available, with an increasing number of institutions making use of practically-based, in-service training programmes which allow trainees to reflect on their own work environment. The first steps towards developing distance learning programmes have also been made in the last couple of years.

Despite these gains, however, the review proposes that there are at present some areas of weakness which will impede the current phase of transformation in management development training in the country. These include, the lack of adequate staffing within the provincial Human Resource Development and Training Units the existence of past management systems and protocols which hinder the implementation of new systems and ideas that are explored in the current training programmes and a lack of sufficient investment being placed in supporting the career enhancement of personnel.

The review concludes with a number of proposals and recommendations. Key recommendations include: the development of a nation-wide management training needs assessment based on the particular competencies required of staff at each level within the health service

• the development of coherent and realistic training plans and strategies
• the establishment and maintenance of a provincial management training database and
• the development of creative mechanisms which support trainees in their workplace through processes of mentoring, apprenticeship, and on going support.

The review also proposes that a sample of current health management training programmes be evaluated so that the lessons from models of innovative practice could be shared by -and inform- the training practices in other projects across the country.