Mission Possible: redesigning services in South Africa

“We need to change the culture and the practice of the public service – that’s the bottom line.”

This comment from Pierre Schoonraad, who heads up research and development at South Africa’s Centre for Public Service Innovation (CPSI), is part vision, part mission statement. And it also encapsulates the activities and ambition of CPSI since its launch back in 2001.

Nowadays, of course, there is no shortage of similar labs and organisations – their prevalence a testament to the enduring challenges facing governments across the globe. CPSI, though, has been present far longer than most. Reporting directly to South Africa’s Minister for Public Service and Administration, its team chips away at the eclectic challenges and opportunities that underpin any effort to foster innovation in the public sector. A key part of their approach, says Schoonraad, is “facilitation”, a word that he uses time and again to describe CPSI’s work.

“I can’t tell a medical doctor how to innovate – the best way is to get the practitioners themselves to do the innovating,” he says. “So we need to build and facilitate a culture and environment for them to be able to do so. We do this through knowledge-sharing and facilitating processes and people – bringing them together to identify best practices and help create new solutions.”

Partnering for progress

Schoonraad has been working at CPSI for nearly a decade – a length of time that reflects both his personal commitment to the cause of public sector innovation and also, perhaps, the length of time it takes for government reforms to scale and implement.

CPSI is cross-sector and facilitates pilot projects but it does not deliver services, focusing instead on developing cross-sector partnerships. It has also, as Schoonraad explains, evolved since its launch.

“We started as a non-profit belonging to government,” he says. “The idea was that because of the risk factors associated with innovation, and public finance management being a difficult animal to deal with, the best way forward would be to establish partnerships with the private sector, donors and NGOs. These would help us experiment, identify the proof of concept, and then bring that into the public sector.”

While initial progress was made, he goes on to say that in order to make a bigger impact a change of approach became necessary. “We realised that you can only do so much as a small lab when government is so wide, and so the focus shifted more to the cultural aspects,” he explains. Prime among these was the development of an awards programme to stimulate competition, something that ran in parallel with similar programmes conducted by the UN, the OECD and others.

“There are so many of these competitions, but innovations unearthed through these competitions are not scaled and don’t find their way into the broader public service,” he explains. “So, what we have done is to ensure that the awards become the middle point of the programme, where you recognise innovators and encourage others to be innovative. After the awards, the real work starts when we select replicable projects and then support and facilitate their scaling.”

Innovation in practice – SA style

So, where are the best innovations occurring in South Africa’s public services? Schoonraad says there many examples, both large and small, but they are all different. “Every project has its own uniqueness,” he points out. “This means you have to redesign your strategy each time – there is no one recipe you can always follow.”

The administration of blood products in hospitals is a case in point. “South Africa has got a scarcity of these supplies, so much so that – depending on the season – we may have only one day’s reserve of blood,” he adds.

“Blood is very expensive – it’s free when you give it, but the cost of processing is such that just one unit of blood costs about US$50, so this is a huge cost item for a hospital. So, what one hospital did was produce a very simple accountability system based on the latest research on what you need blood for and what you don’t need it for. It takes one minute – the doctor who requests the blood has to take accountability for what, why and how; a quick tick-box solution. Over a period of three years, this hospital saved the equivalent of US$2 million in blood units that were not wasted.”

CPSI then stepped in by facilitating workshops with other medical practitioners, and a number of other hospitals are starting to replicate with the same kind of solution. “In this case it was easy – the replication was simply down to knowledge-sharing – but in other projects it’s a little bit more difficult,” says Schoonraad.

“A further example is that we have a backlog for cataract eye operations. There is a hospital in India that has changed the way the theatre operates, so they can do two operations at once by the way they rotate the processes. Eerste River Hospital in Cape Town picked up this approach, adapted these new protocols for the local context, and entered for our Awards. Chris Hani Baragwanath Hospital in Soweto, which had a backlog of about 4,000 operations, picked it up from the Awards and requested our support. We facilitated the replication of this solution because the need was clearly expressed. This, however, required more of a technical intervention because operating theatres had to be rearranged, equipment procured, and you had to engage with their staff in greater detail.”

Away from the health sector, an example can also be found in the country’s informal settlements – where families and individuals reside but have no permanent address. “The police came to us because they had a problem with response times,” he recalls. “If there is a crime committed, the victim’s mobile phone is usually taken at the same time, so they can’t report it. The general response time was up to 48 hours, and by that time the crime scene is contaminated and they can’t really do anything.

“So, we worked with some entrepreneurs to develop a simple household alarm system, linked via text message to the patrol vehicle and to the local community policing forum. It is GPS-located, so the police know exactly where to go and the response time has come down to seven minutes.  The fact that community members and neighbours are also alerted, not only to incidents of crime but also other emergencies such as a fire or medical emergency, has resulted in creating a much more caring and responsive community.”

Bringing it all together

These three examples – and there are plenty more to choose from – showcase how CPSI is seeking to move the innovation agenda forward, and Schoonraad has a particularly important role to play. “As the person responsible for R&D, I engage with departments on wicked problems, identify where current solutions are not working, and we investigate where the challenges are,” he explains.

“To use an analogy from the health sector, often it’s a case of people dealing with the symptoms and not the underlying causes. So, what we try and do is help them understand the root causes and see if there are solutions out there globally. If we don’t find suitable solutions, then we start a development process, working with NGOs, young entrepreneurs and others to create what is needed – as with the GPS alarm in the informal settlements.”

It’s exactly these kind of successes that have seen CPSI endure and flourish for so many years. An entrenched fixture on the South African public sector scene, few would bet against it enduring for many more years to come.

 

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