PBRS
1.17 Broad objective
1.16.3 Three-fold hypothesis: To what extent is it unique to Botswana?
Socio-economic development in African countries, which attained their national independence in the late 1950s and 1960s, had depended on the effectiveness of the public sector in the different countries to succeed. Writers such as Garnham and Haque, (cited in Ayee, 2005) state, however, that generally the public sector was not able to perform its function effectively due, amongst other reasons, to its indifference towards public needs and demands.
The literature indicates that most of the strategies undertaken by African states to improve the performance of their public services have not been able to achieve desired results due to constraints of a political, historical, economic, institutional and cultural nature. Following studies in Sub-Saharan Africa, Kuada (2003) notes that scholars have emphasised the importance of context, especially the cultural context, to the behaviour of managers and administrators in the public sector. He noted that indications are that development is constrained rather than supported by the social structures and relationships within the traditional societies. From a cultural perspective, studies of the behaviour of African managers showed a lack of the generally accepted principles of good management with evidence of wanton indifference to organisational performance, poor strategic management and unsatisfactory productivity levels. The economic success of Botswana, which has been singled out as one of the most remarkable in Africa, has been criticised in some circles as having been beneficial to a few elites at the expense of the majority.
Unfavourable government policies, poor management practices and negative employee attitudes all combine to support the view of an African continent with a public sector that has a culture of poor implementation of performance improvement initiatives. The framework for the hypotheses in this study is, therefore, not unique to Botswana even though it is nuanced by the specific cultural features of the Batswana.
1.17.1 Specific objectives
The specific objectives of this study are to:
1. assess the performance of the improvement initiatives from the point of view of the policy makers 2. assess the health sector staff knowledge and their perception of the effectiveness and efficiency of
the performance improvement initiatives.
3. examine the perceptions of the health sector staff regarding internal equity and their empowerment to implement the performance improvement initiatives.
4. examine the perceptions of health service consumers on the quality of health care received.
5. To explore the various mechanisms of empowerment and equity in health services provision among the consumers of health services.
6. make recommendations to the Botswana Ministry of Health based on the study findings.
1.17.2 Research questions
i) What are the expectations of the policy makers on the outcomes of the PIIs implementation?
ii) To what extent are the health sector staff aware of the existence of the performance improvement initiatives and what are their perceptions on the effectiveness and efficiency of the initiatives?
iii) What are the opinions of health staff regarding internal equity and their empowerment to implement performance improvement initiatives?
iv) What are the perceptions of the health service consumers regarding the quality of services in the wake of the introduction of performance improvement initiatives?
v) What are the opinions of health service consumers on the fairness of access to health care and what empowerment mechanisms are in place to facilitate such access?
1.17.3 Relationship of broad objective to the hypotheses
The rationale for the three hypotheses in this study came from concerns raised in official Government circles about perceived poor work performance in the public sector. The hypotheses, as indicated in section 1.16.2 are: performance improvement initiatives were imposed in a top-down manner in the Botswana health sector with the noble belief that they were valuable in contributing towards the
achievement of the goals of Vision 2016; there is limited knowledge on the part of the health workers at the operational level regarding the usefulness of the performance improvement initiatives and this contributes to their low uptake of the initiatives in the Botswana health sector; the frequency of
complaints by health services consumers is a reflection of the poor quality of health services provided in the health sector in Botswana.
The hypotheses led to the broad objective. The extent to which performance problems in the Botswana health sector could be associated with limited knowledge on the performance improvement initiatives and the factors that may contribute to the perceived low quality health services in the Botswana public health sector were explored. The study involved an examination of the opinions of the senior management in the Ministry of Health regarding the effectiveness and efficiency of the initiatives and the manner in which the initiatives were introduced to the staff. The investigator sought to find out why the initiatives do not seem to achieve the desired results, in view of the points stated in the hypotheses. The study explored the manner in which strategic preparations are undertaken regarding the planning mechanisms for introducing the initiatives and the extent to which the management process ensured the requisite participation of stakeholders during the implementation of the initiatives. The information obtained served as the basis for achieving the objective of making recommendations to key personnel in the health sector on how to enhance the quality of evidence at the levels of policy formulation, implementation and evaluation.
A literature search indicated that major type changes tend to fail more often compared to smaller changes since they require more participant commitment, knowledge and adaptation to organisational culture.
Improvements that require a cultural change of the participants, for example, take longer as they necessarily have to overcome greater resistance to change. Where the cultural characteristics required major transformational changes, it was important to find out how the process of instilling values such as commitment and the ability to adapt to a new way of operating in health sector organisations is handled in Botswana.
The objectives of the study, in relation to the hypotheses, are to examine the importance of the human factor in the selection of organisational improvement initiatives. The exploration of the means by which organisations carried out their strategic functions in the planning for and implementation of initiatives is meant to assess the view that there is limited knowledge on the performance improvement initiatives as outlined in the hypotheses and this took cognisance of the fact that it takes time to have stakeholder acceptance and implementation of initiatives.
The study objectives facilitated the exploration of the hypotheses to gain an understanding of how the health sector performance improvement initiatives were implemented with particular reference to whether the initiatives were implemented continually or continuously. The continual introduction of initiatives
would imply that the implementation process would have allowed pauses between implementing new changes to allow for reflection and stabilisation of the change before the next improvement was made while the continuous application of new initiatives would indicate a less systematic way of managing the improvement process. The relationship of the objectives of the study to the hypotheses is as indicated in Figure 1.4 below;
Figure 1.4: Relationship of research objectives to hypotheses