Professional management in the public health sector is a key factor if the implementation of a National Health Insurance (NHI) is to stand any chance of success. Ailing state facilities can be turned around by proper management, as shown by the shining example of Frere Hospital in the Eastern Cape, where a new hospital manager turned a shambolic institution into something that resembles the Department of Health’s proposed ideal clinic model. But what if it is the provincial department that is incompetent? The negative effect of poor management is then spread over a much larger area. A sterling example of failing management at a provincial level is the Xhariep District Hospital in Trompsburg, completed in 2013 at a cost of around R500m to South African taxpayers. Subsequently, further great sums of money were spent on building staff housing in Trompsburg to accommodate nurses and doctors, and on equipping the radiology department with state-of-the-art scanning and X-ray equipment. It...

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