No need for needs norms--why central planning cannot work for health care

It is widely recognised that South Africa, like other countries, has inequities in health and in access to health care. Centralised formal planning is used by the Department of National Health and Population Development and advocated by others as the approach to social justice and equitable distribution of health care resources. This approach is typical of the central planning of command economies. The reasons why central planning cannot work for health care are explained and an alternative approach is suggested which emphasises decentralised management. This is in line with recent policy statements by the Minister of Health that place a high priority on decentralisation and democratisation. The proposal has important implications for the way in which information systems are developed and used. Much information that central planners say they need is also required for effective management, but with some crucial differences. Planners use ad hoc historical information with little understanding of the local context. Managers, in contrast, regularly need current information for use within the local context. It is therefore recommended that efforts by central planners to acquire information be redirected towards building the capabilities of the health care services to provide and use information for management at all levels.