Bringing Deeper Competency to South Africa’s Healthcare System
Eric Buch, one of the co-founders and now a Co-Director of the Albertina Sisulu Executive Leadership Programme in Health (ASELPH), says that his career as a doctor and a healthcare manager showed him directly what kind of health services the country still needs to build the South Africa of the future.
“Over the past decade, I did health development work across Africa as the health advisor for the New Partnership for Africa’s Development (NEPAD),” Buch says. “I saw the challenge of a lack of top-end executive leaders and managers.” That experience was critical in helping develop the curriculum for the management training program, he says. “In conceptualizing the idea of the ASELPH executive leadership program, it was essential to understand why this particular niche or gap was so critical to fill, what kind of contribution it could make, and what kind of program was required.
Buch is Professor of Health Policy and Management in the School of Health Systems and Public Health at the University of Pretoria. He has served as Deputy Director General for Health Care of Gauteng Province in South Africa, as Executive Director for Health, Housing and Urbanisation of metropolitan Johannesburg, and as General Secretary of the National Progressive Primary Health Care Network, an anti-apartheid health organization.
Give us some context for the Albertina Sisulu Executive Leadership Programme in Health (ASELPH) and its role in South Africa’s health transformation agenda.
Twenty years into democracy, we have made important progress in a number of areas in our health system, in line with achieving the goal of equitable, affordable, good quality healthcare for all.
But the reality is that inequity still defines much of our health system, and poor system performance is widespread. South Africa invests a large amount of its resources in its health system, yet I think most people would agree that we are not getting adequate value for money.
There have been a number of important developments, such as the number of people on AIDS treatment. But if we want to transform the health system and provide quality essential care for all South Africans, we have to get more value for the funds available. These issues need to be dealt with if we want to serve our people properly.
I think most analysts would agree that one of the most critical shortfalls is a lack of sufficient top executive leadership in the health sector. That’s precisely the gap that ASELPH is trying to fill.
What are some of the specific problem spots?
We’ve seen quite significant failures in leadership, starting with moral failures around corruption and nepotism, through to operational failures in effectiveness in managing the system components. We’ve seen weaknesses in human resource management, in supply systems, and in health professional performance. We’ve seen problems with allocative inefficiencies and with resources being applied inappropriately. We’ve seen weak preventive programs.
There have been a number of exciting successes — such as free healthcare for mothers and children, improvements in tuberculosis care, and a number of very good health programs, such as those against tobacco. But we have found that many leaders at the hospital, district and primary healthcare level have not been able to mobilize and motivate their staffs adequately. These managers have often not been able to ensure efficient and effective systems and resource allocation. These are the areas for which ASELPH is trying to develop competence.
What are ASELPH’s primary goals over the next few years?
We set out to achieve two key goals. The first is to train a cadre of executive leaders and managers to meet the unique needs and challenges of South Africa’s public health system. We’ve just graduated our first cohort and we’re really excited with their accomplishments, and we’ve got more cohorts to come.
The second objective is to build a South African lecturer capacity to teach from a health perspective at the top executive level. We want to develop the pedagogies, the case studies, and the mentoring model, so that we have a program that continues sustainably long into the future.
We feel a strong responsibility towards our South African Minister of Health, Aaron Motsoaledi, and the National Department of Health who have backed us. They’ve trusted us. We feel the burden of that trust and responsibility, and the imperative to deliver on it. I would hope the Minister can one day go to a district and say, “This district is fantastically managed. It’s an example of what we’re trying to strive for in the country. Why do you feel you’re different?” and that he’ll hear “I was an Albertina Sisulu Fellow.”
What inspired you to pursue a career in healthcare?
At a very personal level, my being Jewish came into the picture. As a student, I had the opportunity to visit Yad Vashem, the Holocaust memorial in Jerusalem. Walking through there, the similarity between Nazi Germany in the 1930s and apartheid South Africa was very, very stark. We had many family members, including most of my grandfathers’ siblings and their families, who were victims of the Holocaust. So I asked myself the question: What are you going to do about what’s happening in your own country?
Is there a moment over the past two years that really epitomized for you how ASELPH is making a difference?
With our first cohort of Albertina Sisulu Executive Leadership Fellows, we were talking about strategy during their first week, discussing the South African context and what we were trying to achieve. The students became so enthused that of their own accord they said they wanted to create an Albertina Sisulu pledge that committed them to being the kind of leaders and managers our country needs. They wanted the pledge to truly befit the name and the memory of Albertina Sisulu and the kind of leader she was: humble but committed, willing to make sacrifices but strong.
We are trying to train executives who can think innovatively and creatively, who can find new solutions, lead energetically, and motivate. We have tried to build all of this into the curriculums, teaching methods, and learning approaches we use. We’ve tried to put together a really different package, based on what we’ve learned from what has been offered over the past decade or two. It was just so exciting that the Fellows had so quickly grasped the essence of the kind of program we were trying to develop and the outcomes we were trying to achieve.
In selecting the first group of Fellows, we put a lot of effort into recruitment and selection. We interviewed people around the country. What was really exciting is when our colleagues from Harvard University, who’ve trained around the world, said that this is one of the best groups they’ve ever had in training. They were pleased with the motivation, the insights and the class discourse.
It’s still early in the program, but the students are telling us stories about how they’ve been applying what they have learned — almost creating an action-learning methodology.
What words of encouragement would you offer to all who are part of South Africa’s healthcare system leadership?
I think every leader needs to understand the difference he or she can make. We need leaders who are committed to serving our people and in particular the poorest of the poor. The encouragement I would offer is that even in the most difficult times, our leaders must continue to strive to build a healthcare system that befits our struggle against apartheid and the goals of Nelson Mandela. If healthcare leaders get their satisfaction internally from the difference they can make, then we’ll build a health system worthy of our democracy.