Program sustainability post PEPFAR direct service support in the Western Cape, South Africa

Background Public health practitioners have little guidance around how to plan for the sustainability of donor sponsored programs after the donor withdraws. The literature is broad and provides no consensus on a definition of sustainability. This study used a mixed-methods methodology to assess program sustainability factors to inform donor-funded programs. Methods This study examined 61 health facilities in the Western Cape, South Africa, supported by four PEPFAR-funded non-governmental organizations from 2007 to 2012. Retention in care (RIC) was used to determine health facility performance. Sustainability was measured by comparing RIC during PEPFAR direct service (20072012), to RIC in the post PEPFAR period (2013 to 2015). Forty-three semi-structured in-depth interviews were conducted with key informants. The qualitative data were used to examine how predictor variables were operationalized at a health facility and NGO level. Results Our qualitative results suggest the following lessons for the sustainability of future programs: Sufficient and stable resources (i.e., financial, human resources, technical expertise, equipment, physical space) Investment in organizations that understand the local context and have strong relationships with local government. Strong leadership at a health facility level Joint planning/coordination and formalized skill transfer Local positive perceived value of the program Partnerships Conclusion Sustainability is complex, context dependent, and is reliant on various processes and outcomes. This study suggests additional health facility and community level staff should be employed in the health system to ensure RIC sustainability. Sustainability requires joint donor coordination with experienced local organizations with strong managers before during and after program implementation. If the program is as large as the South African HIV effort some dedicated additional resources in the long term would be required.

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Political Transformation and Education Sector Performance in South Africa

The Politics of Education in Developing Countries ◽

10.1093/oso/9780198835684.003.0006 ◽

2019 ◽

pp. 105-131

Author(s):

Brian Levy ◽

Robert Cameron ◽

Ursula Hoadley ◽

Vinothan Naidoo

Keyword(s):

South Africa ◽

Relative Strength ◽

School Level ◽

Local Context ◽

Western Cape ◽

Political Transformation ◽

Low Level ◽

Political Patronage ◽

Public Bureaucracy ◽

Policymaking And Implementation

This chapter explores how political and institutional constraints influenced education policymaking and implementation in South Africa at national, provincial, and school levels. Stark differences between the Eastern and Western Cape provinces offer a natural experiment for exploring how context matters. The Eastern Cape’s socio-economic, political, and institutional legacy resulted in a low-level equilibrium trap—one where multiple political patronage networks were mirrored by a factionalized, fragmented bureaucracy. The Western Cape, by contrast, enjoyed a more supportive environment for the operation of public bureaucracy. However, bureaucracy need not be destiny. The research also found that strong hierarchy can result in formal compliance and a low-level equilibrium of mediocrity. Participatory school-level governance potentially can improve outcomes. Whether this potential is realized depends on the relative strength of developmentally oriented and predatory actors, with the outcomes not foreordained by local context, but contingent and cumulative.

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The Politics and Governance of Basic Education

10.1093/oso/9780198824053.001.0001 ◽

2018 ◽

Cited By ~ 1

Keyword(s):

South Africa ◽

Basic Education ◽

Relative Strength ◽

School Level ◽

Local Context ◽

Western Cape ◽

Eastern Cape ◽

Low Level ◽

Individual Agency ◽

Public Bureaucracy

This book brings together scholars from multiple disciplines to explore how political and institutional context influences the governance of basic education in South Africa at national, provincial, and school levels. A specific goal is to contribute to the crucial, ongoing challenge of improving educational outcomes in South Africa. A broader goal is to illustrate the value of an approach to the analysis of public bureaucracies, and of participatory approaches to service provision which puts politics and institutions at centre stage. Stark differences between the Eastern Cape and Western Cape provinces offer something of a natural experiment for exploring the influence of context. The Eastern Cape’s socio-economic, political, and institutional legacy resulted in a low-level equilibrium trap in which incentives transmitted from the political to the bureaucratic levels reinforced factionalized loyalty within multiple patronage networks, and which is difficult to escape. The Western Cape, by contrast, enjoyed a more supportive environment for the operation of public bureaucracy. However, bureaucracy need not be destiny. The research also shows that strong hierarchy can result in ‘isomorphic mimicry’—a combination of formal compliance and a low-level equilibrium of mediocrity. Participatory school-level governance potentially can improve outcomes—as a complement to strong bureaucracies, or as a partial institutional substitute where bureaucracies are weak. Whether this potential is realized depends on the relative strength of developmentally oriented and predatory actors, with the outcomes not fore-ordained by local context, but contingent and cumulative—with individual agency by stakeholders playing a significant role.

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THE CHALLENGES OF OFFERING PUBLIC SECOND TRIMESTER ABORTION SERVICES IN SOUTH AFRICA: HEALTH CARE PROVIDERS' PERSPECTIVES

Journal of Biosocial Science ◽

10.1017/s0021932011000678 ◽

2011 ◽

Vol 44 (2) ◽

pp. 197-208 ◽

Cited By ~ 18

Author(s):

J. HARRIES ◽

N. LINCE ◽

D. CONSTANT ◽

A. HARGEY ◽

D. GROSSMAN

Keyword(s):

South Africa ◽

Health Care Providers ◽

Service Providers ◽

Team Building ◽

Physical Space ◽

Western Cape ◽

Second Trimester ◽

Care Providers ◽

Trimester Abortion ◽

Second Trimester Abortion

SummaryAround 25% of abortions in South Africa are performed in the second trimester. This study aimed to better understand what doctors, nurses and hospital managers involved in second trimester abortion care thought about these services and how they could be improved. Nineteen in-depth interviews with abortion-related service providers and managers in the Western Cape Province, South Africa, were undertaken. Data were analysed using a thematic analysis approach. Participants expressed resistance to the dilation and evacuation (D&E) procedure, as this required more active provider involvement. Medical abortion was preferred as it required less provider involvement in the abortion process. A shortage of providers willing to perform D&E resulted in most public sector services being outsourced to private sector doctors. Respondents noted an increased demand for services and a concomitant lack of infrastructure, physical space and personnel to respond to these demands, sometimes resulting in fragmented or poor quality care. At medical induction sites, most thought introducing the combined mifepristone–misoprostol regimen would improve service capacity, although they were concerned about cost. Improving contraceptive services was also seen as a much-needed intervention to improve care and prevent abortion. Ongoing training, including values clarification, as well as emotional support and team-building for providers are needed to ensure sustainable, high-quality second trimester abortion services.

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Alternative mechanisms for delivery of medication in South Africa: A scoping review

South African Family Practice ◽

10.4102/safp.v63i1.5274 ◽

2021 ◽

Vol 63 (1) ◽

Author(s):

Robert Mash ◽

Carmen Christian ◽

Ruvimbo V. Chigwanda

Keyword(s):

South Africa ◽

Scoping Review ◽

Health Workers ◽

New Technology ◽

Home Delivery ◽

Patient Choice ◽

Local Context ◽

Economic Evaluations ◽

Western Cape ◽

Scoping Reviews

Background: The number of people in South Africa with chronic conditions is a challenge to the health system. In response to the coronavirus infection, health services in Cape Town introduced home delivery of medication by community health workers. In planning for the future, they requested a scoping review of alternative mechanisms for delivery of medication to patients in primary health care in South Africa.Methods: Databases were systematically searched using a comprehensive search strategy to identify studies from the last 10 years. A methodological guideline for conducting scoping reviews was followed. A standardised template was used to extract data and compare study characteristics and findings. Data was analysed both quantitatively and qualitatively.Results: A total of 4253 publications were identified and 26 included. Most publications were from the last 5 years (n = 21), research (n = 24), Western Cape (n = 15) and focused on adherence clubs (n = 17), alternative pick-up-points (n = 14), home delivery (n = 5) and HIV (n = 17). The majority of alternative mechanisms were supported by a centralised dispensing and packaging system. New technology such as smart lockers and automated pharmacy dispensing units have been piloted. Patients benefited from these alternatives and had improved adherence. Available evidence suggests alternative mechanisms were cheaper and more beneficial than attending the facility to collect medication.Conclusion: A mix of options tailored to the local context and patient choice that can be adequately managed by the system would be ideal. More economic evaluations are required of the alternatives, particularly before going to scale and for newer technology.

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