A model for organisational readiness and implementation of the proposed National Health Insurance Bill : the case of the North West Provincial Department of Health

Abstract

The challenges facing the health system of South Africa and the imbalances occurring between the public and private health system has led the government to introduce radical health care changes in the form of the National Health Insurance Bill, to achieve Universal Health Coverage. Adequate research has shown that the challenges facing the health system of South Africa are also hampering the effective and efficient organisational functioning of the North West Provincial Department of Health. Thus, the primary objective of this study has been to investigate whether the North West Provincial Department of Health is ready to implement the proposed National Health Insurance Bill (NHI) once it becomes legislation. To achieve the above primary objective, four research questions and objectives were formulated that aimed to investigate organisational theories and readiness, best practices and principles associated with effective implementation of public policies, legislative and statutory frameworks, and an empirical data-collection investigation. The results of this study were achieved by means of a qualitative method within a case study design. The instruments and data collection methods comprised of semi-structured interviews, a questionnaire, and document analysis, to increase the validity of semi-structured interviews and a data-collection questionnaire. The research sample comprised of knowledgeable individuals employed by the North West Province Department of Health, including line managers in public clinics and -hospitals. The results from respondents were analysed using a thematic information and data analysis. The findings of the study indicated that the North West Provincial Department of Health is not yet ready to implement the proposed National Health Insurance Bill once it becomes legislation due to significant challenges such as a lack of health professionals, insufficient budgeting, poor infrastructure and inadequate medical equipment. The study presented a model for organisational readiness and -implementation as significant contribution in order to assist the Department with implementation of the proposed National Health Insurance Bill once it becomes legislation. The model has both a structural- and psychological perspective taking into consideration the challenges faced by the institution. Addressing organisational challenges is one step closer in achieving organisational readiness which is underscored by components such as clarity, collaboration, capabilities, and organisational culture.