Assessing the legislative and regulatory framework supporting the management of records in South Africa’s public health sector

Abstract

Background: The process of improving the quality of health care delivery requires that health systems function efficiently and effectively. A key component of health care systems’ efficiency is the administration of records that are often poorly managed. Any improvement in the management of records has to be done in full cognisance that records are generated in an organisational setting and based on a national legislative and regulatory framework.Objectives: The purpose of this article is to assess the contextual legislative and regulatory framework of South Africa’s health care system and its impact on the effectiveness of records management in public health care institutions.Method: Data for the study were obtained from two sources. On the one hand, the study conducted a review of literature that not only provided background information but also informed the research process. On the other hand, a varied number of respondents were identified through purposive sampling, and their expert knowledge solicited through semi-structured interviews.Results: The literature review, as well as the interviews, revealed that findings on the legislative and regulatory environment are multi-layered. For instance, respondents echoed observations made from the literature review that, whilst South Africa had a complex array of legal instruments, compliance levels at public health institutions were very rudimentary and contrary to the levels of sophistication expected by the legal instruments. A number of respondents noted the lack of specific guidelines for health records and that in most government departments there was ‘a very low key focus on the regulatory issues’. Several respondents stated that even when there were general guidelines for managing records, very few public institutions were compliant. A majority of the respondents noted a lack of an integrated approach in the different legislative and regulatory instruments, for instance, on the issue of records retention.Conclusion: The study revealed three related observations: firstly, that there is substantial legislative and regulatory dissonance in the management of health records in the country’s public health sector; secondly, understanding the complex interplay of different legal and regulatory instruments in the country’s public health sector is a critical first step, but it remains the beginning of the process; thirdly, there are lessons to be drawn from the extensive experiences of other countries such as the United Kingdom in addressing the legislative and regulatory challenges.