ASSAf briefing on 2024 Consensus Study: Health System Governance and Management

Video The Portfolio Committee on Science, Technology and Innovation received a briefing from the Academy of Science of South Africa (ASSAf) on its 2024 consensus study on governance and management in the South African health system. ASSAf explained that the study had been initiated independently through its Standing Committee on Health and was not commissioned by government. The study examined how governance and leadership affected access to quality healthcare and identified leadership instability, political interference, weak accountability, inadequate delegation of authority, poor management systems, limited community participation and corruption as significant concerns. Recommendations included merit-based appointments, stronger management capacity, improved accountability and transparency, appropriate delegation of decision-making authority, better support systems and stronger protection for whistle-blowers. Members interrogated the implications of the findings for the National Health Insurance (NHI) and the broader health system. Discussion covered centralisation and decentralisation, political oversight and interference, public-service professionalisation, procurement controls, regulatory bodies, rural representation, public participation, health-system financing and the role of science, technology and innovation. Members also questioned how Parliament could ensure that recommendations from inquiries and research were implemented rather than repeatedly remaining outstanding. ASSAf clarified that the study relied on literature, stakeholder engagement and expert deliberation rather than a nationally representative survey. It had nevertheless sought input from government, civil society, labour, rural health organisations and other stakeholders. The panel had experienced significant differences of opinion, particularly on NHI governance, but reached consensus through extensive deliberations, workshops and external expert input. The Acting Chairperson indicated that the Committee would continue engaging on the report with the Minister and other relevant stakeholders.