| 53. | Leadership and governance challenges remain prevalent in the various levels of the public sector. Despite efforts by government to inculcate a culture of good leadership and governance, the knowledge and skills amongst managers is still very inadequate. Furthermore, weak accountability mechanisms are linked to inadequate, disparate measures and standards for managing performance (good or poor). Poor accountability is also exacerbated by a semi-federal public sector. The private sector also has weak systems of governance and leadership as it remains poorly regulated and less accountable in terms of quality and costs. Poor clinical governance in the private sector is demonstrated by the caesarean section rate where 62% of women delivering in the private sector had C-sections, and increased delivery-related health costs in the private sector by at least 10-fold , compared with 18% in the public sector31. |
