scholarly journals Strengthening public financial management in the health sector: a qualitative case study from South Africa

2021 ◽  
Vol 6 (11) ◽  
pp. e006911
Author(s):  
Jodi Wishnia ◽  
Jane Goudge
Keyword(s):  
South Africa ◽  
Service Delivery ◽  
Low Income ◽  
Financial Management ◽  
Boundary Crossing ◽  
Multidisciplinary Teams ◽  
Health Coverage ◽  
Structured Interviews ◽  
Public Financial Management

IntroductionEffective public financial management (PFM) ensures public health funds are used to deliver services in the best way possible. Given the global call for universal health coverage, and concerns about the management of public funds in many low-income and middle-income countries, PFM has become an important area of research. South Africa has a robust PFM framework, that is generally adhered to, and yet financial outcomes have remained poor. In this paper, we describe how a South African provincial department of health tried to strengthen its PFM processes by deploying finance managers into service delivery units, involving service delivery managers in the monthly finance meeting, using a weekly committee to review expenditure requests and starting a weekly managers’ ‘touch-base’ meeting. We assess whether these strategies strengthened collaboration and trust and how this impacted on PFM.MethodThis research used a case study design with ethnographic methods. Semi-structured interviews (n=30) were conducted with participant observations. Thematic analysis was used to identify emergent themes and collaborative public management theory was then used to frame the findings. The authors used reflexive methods, and member checking was conducted.ResultsThe deployment of staff and touch-base meeting illustrated the potential of multidisciplinary teams when members share power, and the importance of impartial leadership when trying to achieve consensus on how to prioritise resource use. However, the service delivery and finance managers did not manage to collaborate in the monthly finance meeting to develop realistic budgets, or to reprioritise expenditure when required. The resulting mistrust threatened to derail the other strategies, highlighting how critical trust is for collaboration.ConclusionEffective PFM requires authentic collaboration between service delivery and finance managers; formal processes alone will not achieve this. We recommend more opportunities for ‘boundary crossing’, embedding finance managers in service delivery units and impartial effective leadership.

scholarly journals Barriers and Challenges to Service Delivery and Funding: A Case Study of a Nonprofit Organization in the Western Cape, South Africa

2019 ◽  
Vol 5 (3) ◽  
pp. 293
Author(s):  
Simone Martin-Howard
Keyword(s):  
South Africa ◽  
Service Delivery ◽  
Nonprofit Organizations ◽  
Low Income ◽  
Underserved Populations ◽  
Single Case ◽  
Western Cape ◽  
Staff Members ◽  
Barriers And Challenges

There is limited qualitative case research focusing on the underreported voices of black and coloured men and women employed at nonprofit organizations (NPOs) and living in underserved communities of South Africa. The purpose of this single case study, then, is to explore barriers and challenges to service delivery and funding at one specific NPO in South Africa’s Western Cape Province (WCP). To do so, I rely on observations and indepth semistructured interviews with 11 staff members. According to a majority of the staff, religion and race are the primary barriers that prevent the organization from achieving its goals and objectives. Moreover, they note that poverty and poor living conditions, child abandonment and neglect as a result of maternal alcohol abuse, and racial and cultural tensions are contextual challenges that inhibit organizational effectiveness. While these barriers and challenges are specific to this particular NPO, the contextual factors that staff identified are evident in other townships in the WCP. As such, the findings from this study add to the knowledge of NPOs in the WCP and provide insights into how to improve service delivery for low-income and underserved populations in the region.

scholarly journals Drivers of Broad-Spectrum Antibiotic Overuse across Diverse Hospital Contexts—A Qualitative Study of Prescribers in the UK, Sri Lanka and South Africa

Antibiotics ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 94
Author(s):  
Carolyn Tarrant ◽  
Andrew M. Colman ◽  
David R. Jenkins ◽  
Edmund Chattoe-Brown ◽  
Nelun Perera ◽  
...  
Keyword(s):  
South Africa ◽  
Sri Lanka ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Low Income ◽  
System Level ◽  
Comparative Approach ◽  
Structured Interviews ◽  
Public And Private ◽  
The Uk

Antimicrobial stewardship programs focus on reducing overuse of broad-spectrum antibiotics (BSAs), primarily through interventions to change prescribing behavior. This study aims to identify multi-level influences on BSA overuse across diverse high and low income, and public and private, healthcare contexts. Semi-structured interviews were conducted with 46 prescribers from hospitals in the UK, Sri Lanka, and South Africa, including public and private providers. Interviews explored decision making about prescribing BSAs, drivers of the use of BSAs, and benefits of BSAs to various stakeholders, and were analyzed using a constant comparative approach. Analysis identified drivers of BSA overuse at the individual, social and structural levels. Structural drivers of overuse varied significantly across contexts and included: system-level factors generating tensions with stewardship goals; limited material resources within hospitals; and patient poverty, lack of infrastructure and resources in local communities. Antimicrobial stewardship needs to encompass efforts to reduce the reliance on BSAs as a solution to context-specific structural conditions.

Mobile-mediated mothering from a distance: A case study of Somali mothers in Port Elizabeth, South Africa

2020 ◽  
Vol 23 (5) ◽  
pp. 656-673 ◽  
Author(s):  
Celine Meyers ◽  
Pragna Rugunanan
Keyword(s):  
South Africa ◽  
Mobile Technologies ◽  
Structured Interviews ◽  
Mobile Platforms ◽  
Left Behind ◽  
Emotional Bonds ◽  
Distinct Category ◽  
Port Elizabeth ◽  
Educational Pursuits

This article explores the mobile-mediated mothering experiences among migrant Somali mothers living in Port Elizabeth, South Africa. Twenty semi-structured interviews were conducted with Somali mothers to examine how Imo, Viber, Skype and WhatsApp enable them to fulfil important maternal responsibilities toward their left-behind children in Somalia. The findings reveal that three types of maternal tensions occur due to their migration: guilt and concern, family strains, and judgement in Somali communities. Efforts to overcome these tensions include the adoption of mobile technologies to continue to mother from a distance. Migrant Somali mothers in this study mediate mothering using mobile platforms by: (a) transferring remittances to their children’s caretakers, (b) sustaining emotional bonds, (c) teaching religious beliefs, and (d) encouraging educational pursuits. By focusing on mothers as a distinct category of women, this study contributes to the theoretical call for more scholarship on matricentric feminism.

Exploring the Integration of Indigenous Knowledge Into Public Library Services With an Inclusive Intent Using a Critical Theory Lens

2020 ◽  
pp. 266-285
Author(s):  
Maned Mhlongo
Keyword(s):  
South Africa ◽  
Critical Theory ◽  
Indigenous Knowledge ◽  
Public Libraries ◽  
Public Library ◽  
Library Services ◽  
Structured Interviews ◽  
Regulatory Frameworks ◽  
Multiple Case

Despite legislative and regulatory frameworks that have paved the way for transformation and inclusivity of public libraries in South Africa, there seems to be little or no integration of indigenous knowledge (IK). The exclusion of IK from public library services has potential to counteract efforts towards the provision of inclusive services. This chapter demonstrates how critical theory was used as a lens in a multiple case study that explored the integration of indigenous knowledge (IK) into services of public libraries in South Africa. Looking at the articulation of IK, services that are provided to ensure inclusivity, and issues that impact on IK integration in public libraries, semi-structured interviews were conducted from purposefully selected heads of provincial library services in South Africa. Thematic analysis was used. Using critical theory to frame the analysis, findings indicate understanding of aspects of IK including its oral nature. A paucity of engagement with IK as an aspect of inclusive service provision was noted.

Participant Perceptions of Character Concepts in a Physical Activity–Based Positive Youth Development Program

2016 ◽  
Vol 38 (5) ◽  
pp. 481-492 ◽  
Author(s):  
Shaina Riciputi ◽  
Meghan H. McDonough ◽  
Sarah Ullrich-French
Keyword(s):  
Physical Activity ◽  
Youth Development ◽  
Positive Youth Development ◽  
Low Income ◽  
Character Development ◽  
Development Program ◽  
Structured Interviews ◽  
Low Income Families ◽  
The Impact

Physical activity–based positive youth development (PYD) programs often aim to foster character development. This study examined youth perspectives of character development curricula and the impact these activities have on their lives within and beyond the program. This case study examined youth from low-income families in a physical activity–based summer PYD program that integrated one character concept (respect, caring, responsibility, trust) in each of 4 weeks. Participants (N = 24) included a cross section of age, gender, ethnicity, and past program experience. Semi-structured interviews were analyzed using inductive thematic analysis and constant comparative methods. Thirteen themes were grouped in four categories: building highquality reciprocal relationships; intrapersonal improvement; moral reasoning and understanding; and rejection, resistance, and compliance. The findings provide participant-centered guidance for understanding youth personal and social development through physical activity in ways that are meaningful to participants, which is particularly needed for youth in low-income communities with limited youth programming.

scholarly journals Tracking health sector priority setting processes and outcomes for human resources for health, five-years after political devolution: a county-level case study in Kenya

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Joshua Munywoki ◽  
Nancy Kagwanja ◽  
Jane Chuma ◽  
Jacinta Nzinga ◽  
Edwine Barasa ◽  
...  
Keyword(s):  
Service Delivery ◽  
Human Resources ◽  
Priority Setting ◽  
Human Resources For Health ◽  
Health Sector ◽  
Health Service Delivery ◽  
County Level ◽  
Health Coverage ◽  
Middle Income

Abstract Background Health sector priority setting in Low and Middle-Income Countries (LMICs) entails balancing between a high demand and low supply of scarce resources. Human Resources for Health (HRH) consume the largest allocation of health sector resources in LMICs. Health sector decentralization continues to be promoted for its perceived ability to improve efficiency, relevance and participation in health sector priority setting. Following the 2013 devolution in Kenya, both health service delivery and human resource management were decentralized to county level. Little is known about priority setting practices and outcomes of HRH within decentralized health systems in LMICs. Our study sought to examine if and how the Kenyan devolution has improved health sector priority setting practices and outcomes for HRH. Methods We used a mixed methods case study design to examine health sector priority setting practices and outcomes at county level in Kenya. We used three sources of data. First, we reviewed all relevant national and county level policy and guidelines documents relating to HRH management. We then accessed and reviewed county records of HRH recruitment and distribution between 2013 and 2018. We finally conducted eight key informant interviews with various stakeholder involved in HRH priority setting within our study county. Results We found that HRH numbers in the county increased by almost two-fold since devolution. The county had two forms of HRH recruitment: one led by the County Public Services Board as outlined by policy and guidelines and a parallel, politically-driven recruitment done directly by the County Department of Health. Though there were clear guidelines on HRH recruitment, there were no similar guidelines on allocation and distribution of HRH. Since devolution, the county has preferentially staffed higher level hospitals over primary care facilities. Additionally, there has been local county level innovations to address some HRH management challenges, including recruiting doctors and other highly specialized staff on fixed term contract as opposed to permanent basis; and implementation of local incentives to attract and retain HRH to remote areas within the county. Conclusion Devolution has significantly increased county level decision-space for HRH priority setting in Kenya. However, HRH management and accountability challenges still exist at the county level. There is need for interventions to strengthen county level HRH management capacity and accountability mechanisms beyond additional resources allocation. This will boost the realization of the country’s efforts for promoting service delivery equity as a key goal – both for the devolution and the country’s quest towards Universal Health Coverage (UHC).

Classification of Low-Income Countries for the Purpose of Debt Limits in Fund-Supported Programs - 2011 Update

Policy Papers ◽  
2011 ◽  
Vol 2011 (60) ◽  
Author(s):  
Keyword(s):  
Low Income ◽  
Financial Management ◽  
Low Income Countries ◽  
Short Paper ◽  
Executive Board ◽  
Public Financial Management ◽  
Management Capacity

This short paper informs the Executive Board of staff’s assessment of macroeconomic and public financial management capacity (henceforth “capacity”) in PRGT-eligible countries (henceforth “low-income countries”) with Fund-supported programs for the purpose of setting debt limits. Capacity plays an important role in the framework for debt limits. This framework includes a menu of options for concessionality requirements to reflect the diversity of situations in low-income countries (LICs). Eligibility for a particular option is related to an assessment of debt vulnerabilities and capacity.

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