Transferability of policies and organisational practices across public and private health service delivery systems : a case study of selected hospitals in the Eastern Cape : exploring lessons, ambiguities and contradictions

Abstract

Since the advent of South Africa's democracy in 1994 there have been several changes in the policy and legislative arena specifically promoting public-private-partnerships in the health sector. These initiatives have given rise to opportunities for inter-sectoral policy transfer under the rubric of ―best practices‖. This exploratory study examines the character, obstacles and contested nature of a selection of policy transfers between private and public health institutions in a single province of South Africa. The study looks at the dynamics at play around envisaged, current and past transfers of policies and organisational practices in relation to administrative systems and technologies used in four different hospital settings – two public and two private hospitals in the Eastern Cape Province of South Africa. This thesis explores the views of managers and labour organisations about policy transfer focusing on local contexts, and how various parties construct policy transfer, hence providing a perspective of policy at the ―plant‖ level. In this research, special focus is placed on different agents' role and understandings of their contexts and how and why policies move and contradictions of these developments. In-depth interviews were conducted at four major Eastern Cape hospitals. The thesis argues that in practice, policy transfer is messy, politicized and traversed by power and vested interests and that organised labour plays a key role in policy transfer process. The thesis focuses on the different philosophical/ideological underpinnings, socio-political values and operational environments in each sector. This study is designed to contribute to existing knowledge on practices particularly between the public and private sectors in order to widen the understanding of the complexity of transferability.