Corporate Governance Mechanisms for Sustainable Healthcare Service Delivery in Public Hospitals

Introduction

Arguably governments all over the world are responsible for delivering a variety of public services to their citizenry, including education, health care and social welfare services (Van Boven, 2007). An effective public sector that reliably delivers quality public services aligned with citizens preferences, fostering private market-led growth while prudently managing critical public resources is not only for reducing poverty but also the attainment of Millennium Development Goals (Shah, 2005). Recently, demands for service delivery have increased in the advent of current Information and Communication Technology (ICT) revolution empowering citizens to access, transmit, and transform information in ways that governments are powerless to block thereby undermining most authoritative controls and constraining the ability of governments to withhold information from citizens. This revolution has strengthened demands for greater accountability from the public sector for quality service delivery. This wave underlies the contention of the World Health Organization (WHO, 2013) that all people and communities everywhere in the world access quality health care services, which are promotive, preventive and rehabilitative without facing hardships of any nature.

Namibia is one of the countries in Sub-Saharan Africa spending about 15% of its annual income on health care within the Abuja framework since 2019 compared to other countries in Sub-Sahara Africa; that notwithstanding the quality of health care services in the country is still poor (The World Bank, 2020). The Presidential Commission Inquiry (Government of the Republic of Namibia, 2013) described the quality of patient health care in public health facilities as below acceptable standards. Indicators of poor-quality patient health care cited in the report include overcrowding, long waiting queues, inadequate number of qualified healthcare professionals, inadequate equipment and supplies, and poor infrastructure. Additionally, among key health care indicators, Namibia performs poorly in comparison to the average among all upper-middle-income countries in WHO’s AFRO region on life expectancy, health-adjusted life expectancy, and human immunodeficiency virus (HIV) prevalence report (Ohadi, Claire, & Carlos, 2016). These conditions are experienced in Namibia despite the establishment and functioning of a governing body, the Health Professions Council of Namibia (HPCNA) mandated to oversee the operations of healthcare professionals in Namibia. A case in point, the Katutura State Hospital continues to be the subject of patient complaints both in the newspapers (Haidula, 2015) and from the public regarding poor quality health care services. Hence, consequences of not addressing these problems continue to have deleterious and negative effects on the citizens and their confidence in public hospitals.

Given the introductory note, this chapter proposes to qualitatively investigate the role of corporate governance mechanisms and structures in addressing health care services delivery shortfalls in the Namibian health sector, using Katutura State Hospital as a case study. The identification of challenges and stumbling blocks together with their causal channels effecting poor health care service delivery are important for designing effective solutions and interventions in improving service quality. Therefore among others, the following sub-objectives will be pursued: Explore stakeholder perceptions on the state of health care service delivery, determine factors hindering the implementation and proper functioning of effective and efficient governance mechanisms; identify the industry’s best practices in the use of corporate governance mechanisms; and suggest strategies for efficiently and effectively delivering health care services at the case Hospital through corporate governance. Remaining sections are organized as follows. Section two, explores the conceptual background of the topic. Section three explores germane literature underpinning the study and covers corporate governance theories, corporate governance mechanisms, best practices on corporate governance and empirical literature culminating with the study conceptual framework. Section four is the study methodology and represents the study design, strategy, instrumentation, and data analysis, while findings and discussions are in section five. Subsequent sections include study conclusions, recommendations, and finally potential areas on related aspects of the topic going forward not only in Namibia, but also in other developing countries.