oa South African Health Review - Transformation of laboratory services : chapter 12
A comprehensive clinical laboratory service is indispensable to proper patient care. It plays a part in making a diagnosis and influencing treatment decisions in patient care and has public health value. Public health sector laboratory services are very fragmented and range widely in quality. There have been attempts over the years to rationalise and restructure these services and to upgrade the quality where it is poor but there have always been reasons why this has not occurred. The fragmentation of the services has resulted in a loss of economies of scale, especially where highly specialised equipment, expensive reagents and unique skills are concerned. In this chapter, the history of the many players in the provision of the services that is relevant to the developments and the failure to rationalise the services in the past is briefly discussed. For many years all roleplayers have recognised the need to improve the whole laboratory system. Immediately after the 1994 elections the Minister of Health established a commission to investigate the rationalisation and reorganisation of the laboratories. One issue was the joint ownership of the South African Institute for Medical Research (SAIMR) by the Chamber of Mines (CoM). In October 1998 the CoM unconditionally donated their interests in the SAIMR to the government. A Transformation Task Team (TTT) was appointed to make new recommendations for the restructuring of the public health laboratory services. The TTT recommended the establishment of a new parastatal (public entity) and for all public health laboratory services to become a part of that entity. Since May 1999 a Project Implementation Team has been designing the new entity in earnest. The vision is for a single entity that is large enough to derive benefit from economies of scale and therefore to ensure that services can be provided even where they are not independently viable. The control over purchasing services will remain with the clinicians that request laboratory tests. The new entity will employ about 4 500 employees and will have an annual turnover that is expected to be close to R1bn within the next two years. The National Health Laboratory Service Bill has been adopted by Parliament.
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