Hospital autonomy in Zimbabwe

This study compares autonomy at Parirenyatwa Hospital with that of other central hospitals, specifically, Harare Central Hospital. Two other cases are also examined: Wankie Colliery Hospital in Hwange, a private, industrially owned hospital; and Avenues Clinic, a private hospital in Harare. The study covers: (1) the nature and extent of the autonomy of the three hospitals; (2) the process by which autonomy was extended to them and how it has changed over time; (3) the fit between hospital management, organization, internal systems and practices, and the demands imposed by autonomy; and (4) the impact of autonomy. Several lessons emerge from the experience of the facilities studied. (1) Hospital leadership must be committed to implementing expanded autonomy, be able to gain the confidence and cooperation of their staff, and be able to articulate a vision of autonomy to both staff and other hospital constituencies. (2) Existing financial and managerial accounting and billing systems do not allow hospitals to effectively price their services, bill in a timely fashion, budget, manage against budget, or adjust budgets in real time to reflect changing demand or economic circumstances. Upgrading these systems and the staff administering them will be a critical element in implementing any policies that put hospitals at risk for balancing revenues and expenditures. (3) In a decentralized hospital system, the Ministry of Health and Child Welfare must be willing to relinquish authority over senior appointments, staffing, service offerings, and operational management of the hospitals. Issues that the Ministry must resolve if it will move toward decentralized financing and management are discussed in conclusion. Appendices include references and pertinent legislation.