Designing and evaluating the implementation of a monitoring and evaluation system to improve cost efficiency in the surgical department of a central hospital in Gauteng, South Africa
1
Deparment of Community Health, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
2
Public Health, University of Pretoria, Pretoria, South Africa
3
School of Clinical Medicine, University of Witwatersrand, Johannesburg, South Africa
4
Information Management Unit, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
The National Health Insurance (NHI) Act aims to provide universal health coverage to all South Africans. However, a lack of standardized monitoring and evaluation (M&E) systems for financial management and effective resource allocation in public hospitals lead to limited accountability and overspending. The aim of this study is to develop and implement an M&E framework to improve cost efficiency and support data-driven decision-making in the surgical functional business unit (FBU) of a central hospital in the Gauteng Province.
METHODS:
This study imbeds itself in the routine institutional theatre efficiency dashboard reporting framework and adopts an implementation mixed-method approach. Baseline expenditure of perioperative costs (i.e. consultation fees, radiology, anesthesia, operating theatre, theatre equipment, medication, length of stay and facility fees) for open and laparoscopic cholecystectomy were retrospectively analyzed in quarter 3 (Q3) of the 2025/26 financial year.
RESULTS:
Between June and August (Q3), the surgical gastroenterology unit cost-center performed more laparoscopic cholecystectomies (LC) [N=22] than open cholecystectomies (OC) [N=1] with cost analysis demonstrating an estimated perioperative cost of 10 634 ZAR for OC and 8 849 ZAR for LC. Each case cancellation cost the unit 3 748 ZAR of additional expenditure which, over the 3-month period total 63 716 ZAR. Cancellations were due to time constraints caused by delayed theatre start time, turnover time, and the length of complex cases preceding laparoscopies.
CONCLUSIONS:
The study highlights opportunities for M&E-guided cost-reduction decision-making within the gastroenterology cost-center by addressing theatre start time, turnover time, and cancellation rates. Furthermore, this study will establish a standardized clinician-facing expenditure system across all cost-centers to identify cost minimization mechanisms and reduce wasteful cancellations in perioperative service delivery.
The National Health Insurance (NHI) Act aims to provide universal health coverage to all South Africans. However, a lack of standardized monitoring and evaluation (M&E) systems for financial management and effective resource allocation in public hospitals lead to limited accountability and overspending. The aim of this study is to develop and implement an M&E framework to improve cost efficiency and support data-driven decision-making in the surgical functional business unit (FBU) of a central hospital in the Gauteng Province.
METHODS:
This study imbeds itself in the routine institutional theatre efficiency dashboard reporting framework and adopts an implementation mixed-method approach. Baseline expenditure of perioperative costs (i.e. consultation fees, radiology, anesthesia, operating theatre, theatre equipment, medication, length of stay and facility fees) for open and laparoscopic cholecystectomy were retrospectively analyzed in quarter 3 (Q3) of the 2025/26 financial year.
RESULTS:
Between June and August (Q3), the surgical gastroenterology unit cost-center performed more laparoscopic cholecystectomies (LC) [N=22] than open cholecystectomies (OC) [N=1] with cost analysis demonstrating an estimated perioperative cost of 10 634 ZAR for OC and 8 849 ZAR for LC. Each case cancellation cost the unit 3 748 ZAR of additional expenditure which, over the 3-month period total 63 716 ZAR. Cancellations were due to time constraints caused by delayed theatre start time, turnover time, and the length of complex cases preceding laparoscopies.
CONCLUSIONS:
The study highlights opportunities for M&E-guided cost-reduction decision-making within the gastroenterology cost-center by addressing theatre start time, turnover time, and cancellation rates. Furthermore, this study will establish a standardized clinician-facing expenditure system across all cost-centers to identify cost minimization mechanisms and reduce wasteful cancellations in perioperative service delivery.
| eISSN: | 2654-1459 |
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