Please do a conclusion for the following, Designing processes to achieve organisational change

Introduction

Introduction

External context of the Eastern Cape Department of Health

Rainey $(1997)$ in Kuiper at al $(2014)$ broadly distinguishes between private and public organisation by their contextual characteristics and they include; political influence, transection of public goods, clarity on organisational goals, financial crisis, red tapes and central decisions making $($Kuipers et al$.,2014)($Kuipers et al$.,2014).$ Moreover, in terms of Constitutional provisions, the Department of Health mandate is derived from Schedule $4,9,27$ and $28,$ further in terms of National Health framework $(2003)$ which provides a framework for the structure of health care system within South Africa and in addition as set in outcome $2$ of the $2019-2024$ Medium Term Strategic Framework.

In terms of Eastern Cape department of Health, contextual characteristics are identified as follows:

Operating environment $$ Addition

ECDOH has experienced numerical population growth over the years, but other provinces$$ population growth has been steeper, and this has affected the province$$s equitable share allocation $($ECDOH$,2020).$ Thus, the population and demand for services are increasing but the ECDOH$$s budget share is reducing per capita. This will inevitably result in increasing financial constraints for the department, limiting its ability to fund current services and expansion. The Easter Cape is one of the provinces in the country with the highest unemployment rate and a substantial proportion of the population do not have stable source of income, whereas income is one of the social determinants of health. The EC is also a vast province with a large rural portion which has implications for operating logistics$,$ costs and human resources.

Financial challenges Declining Budget

ECDOH like other provincial departments, relies on funding that is appropriated through Equitable Share and conditional grants from the collected revenue and donors. ECDOH is also a non$-$profit entity, which means that it is limited in terms of how it can generate revenue. Allan at el $(2004)$ indicate that the ECDOH$$s per capita budget has been on relative decline since $2002/3$ and this significantly affects the rendering of quality health care services. These challenges adversely affect the planning and execution of DOH strategy to provide efficient and quality services to the public $($Allan et al$.,2004).$

Political influences $$ Addition

The Executive Authority $($EA$)$ dictatess the political mandate and direction for the department to follow. The EA directs policy and priorities for the department which must be operationalized by department. Thus, the administration of health services is overseen by a political head. This has a tendency of creating a state of tension between operations led by the Head of Department $($HOD$)$ and political interests of the EA$.$ The HOD and senior management must manage the inevitable conflicts that arise. This state of tension is complicated by the fact that the performance appraisals and future job prospects of the senior management team may depend on the good graces of the EA$,$ creating potential conflict of interest.

Internal Organisational features of the Eastern Cape Department of Health

$1.$ characterise its internal organisational features $($using the module material to provide the conceptual lens$)$ and their appropriateness for addressing the public value mandate;

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The Department of Health in the Eastern Cape operates with a top$-$down structure, where decisions come from the top and bureaucratic red tape is common $($Willie & Maqbool, $2023($Willie & Maqbool, $2023)).$ While this structure provides stability and clear authority, it can hinder innovation and responsiveness to local needs, making service delivery less efficient. The department grapples with significant challenges stemming from limited financial and human resources $($Willie & Maqbool, $2023)($Willie & Maqbool, $2023).$

Furthermore, the bureaucratic red tape inherent in a top$-$down structure can add additional layers of complexity to decision$-$making processes. Where a local health clinic identifies a need for a new medical equipment or additional staff, they may be required to go through a lengthy approval process involving multiple levels of bureaucracy. This bureaucratic process can result in significant delays in acquiring the necessary resources, which can ultimately impact the quality and efficiency of service delivery $($Willie & Maqbool, $2023)($Willie & Maqbool, $2023).$

Furthermore, access to healthcare varies greatly in the Eastern Cape, with rural areas facing greater difficulties in obtaining quality services. Moreover, inadequate infrastructure, such as poor roads and limited transportation options, exacerbates the challenge of reaching remote communities with medical assistance. Hospitals and clinics in the province are stru