Editorial
Intersectoral collaboration refers to the promotion and co-ordination of the activities of different sectors. Health planners have often identified agriculture, education, water and sanitation, and the environment as those sectors that can, and that should, collaborate in helping to reduce inequities in health. One sector that is rarely given mention however, is the telecommunication sector. Communication is a vital ingredient for the development and smooth operation of health systems and telecommunication is one of the essential mediums to enable this to occur. However, effective and efficient management and delivery of health care in South Africas traditionally under-resourced rural areas is being hampered by the poor telecommunications infrastructure.
Health Systems Trust, through its Initiative for Sub-District Support (ISDS) programme, has established a working relationship with the telecommunication parastatal Telkom. This relationship is based on to an agreement with Telkom that the installation of telephones in ISDS sites will be fast-tracked. This collaboration between the health sector and Telkom is in itself an example of how inter-sectoral interaction can be beneficial to collaborating parties. In this instance the collaboration is a mutually symbiotic one. On the one hand it is helping Telkom to meet its objective of providing a telephone service to what it has identified as its so-called priority customer (i.e. the health sector). Reciprocally, the installation of telephones in clinics, hospitals and district health offices is an important prerequisite for the development of more effective and efficient communication systems for the management and delivery of health care.
The installation of phones in health facilities has also enabled HealthLink to establish electronic-mail networks in some of the ISDS sites. This has in turn enabled health workers not only to have access to an additional and more cost-effective communication tool, but also to have access to the electronic services offered by HealthLink. These services are aimed at improving clinical skills and at giving health workers access to information resources. The e-mail infrastructure also provides HealthLink with the opportunity of enabling better drug management systems in health districts.
The collaboration between ISDS and Telkom has had added benefits in that it has fostered new relationships. In the Impendle/Pholela/Underberg Health District in KwaZulu-Natal a local community in one of the sub-districts has taken advantage of this collaboration. After having been informed of ISDSs initiative to improve communication within the health district, they have taken it upon themselves to pressure the parastatal to expedite the installation of telephones in the local clinic and the school, and within the community itself. They even arranged (through ISDS) to have a Telkom representative address a community meeting on the companys plans for the area. The forum was also used by the community to express their frustration at the lack of urgency on the part of Telkom to install telephones. This level of interaction has not only linked the community to the service provider but it has created a monitoring mechanism for the delivery of telecommunication services. There is no reason why communities and Telkom branches in other parts of the country cannot embark upon similar initiatives.
Although the collaboration between ISDS and Telkom has brought some satisfaction to the health sectors cause, it has its fair share of problems. Problematic because of the incapability of the parastatal to deliver on its promise of installing telephones in a few of the ISDS sites. Telkom is struggling to implement national policy at the ground level. In some parts of the country, notably the former-Transkei and rural Mpumalanga, requests for telephones at some clinics have been bedevilled by logistical problems with local Telkom branches. In the Transkei, the problem relates to the fact that some of these branches are under-resourced by not having the proper equipment to plan installation of services in health facilities. In Mpumalanga, there have been co-ordination problems with the para-statal and the national electricity supplier (Eskom) in the electrification of some of the manual telephone exchanges in the ISDS sites. Such problems have resulted in delays in the provision of a telephone service to the health facilities. This has not only added to the frustration of health workers, but it also continues to hamper ISDSs communication support strategies.
A few lessons can be learnt from the experience that ISDS has had with its relationship with Telkom. For intersectoral collaboration to work, all parties must make sure that their own house is in order. This is especially important for large bureaucratic organisations. The differences in responsibility between the policy makers and those responsible for implementing policy decisions needs to be understood by bureaucracy-governed organisations. Once this is done proper communication channels between the two levels needs to be delineated and maintained.
At the same time steps need to be taken to ensure that those responsible for implementing decisions are not only fully capable, but also adequately equipped to do so. This is especially important if such collaboration is resource-dependent. If necessary, changes in operating procedures need to be carried out by a collaborating party so as not to disadvantage an agreement. If one party cannot fulfil its role adequately then the progress in achieving the objectives of such collaboration is impeded.
Despite the frustrations, the collaboration between the ISDS and Telkom has yielded tangible improvements to telecommunication in some sites in that it has brought many a clinic a telephone. The collaboration illustrates how two very different sectors (health and telecommunication) can work together towards improving the quality of health care, albeit in different ways. |
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