ABSTRACT
The lack of transport to ensure timeous transfer of patients between levels of health care facilities and for delivery of medicines; vaccines; and other essential equipment is a commonly heard cry from health workers; particularly from those working in rural areas; but is often overlooked and rarely researched. It is essential to have the correct vehicle mix and a sound transport management system to ensure efficient and effective health service delivery. Public sector transport policies and management systems in South Africa are complex. Policy decisions for the management of the national fleet are set by the national Department of Transport; remote from the level of service delivery. The provincial departments of Transport lease vehicles for service delivery to user departments; such as the Department of Health. A Fleet Management Service Provider is contracted to the national Department of Transport to coordinate fuel and oil purchases and maintenance of the national fleet. Management of the national fleet has been identified by the national Department of Transport (NDoT) as not being part of the core business of the department. The policy direction of the NDoT is to outsource the management of the national fleet; (as has been done in the Northern Cape Province); and improve the subsidised car scheme for public servants. How these policy decisions will affect health service delivery is not known; particularly within a decentralised health system. This chapter explores some of the complexities of the present transport management systems for health service delivery within the public sector through three provincial case studies; namely Limpopo; Mpumalanga and Gauteng. Some recommendations for improved management and for further research are made