Opening decision spaces: a case study on the opportunities and constraints in the public health sector of Mpumalanga Province, South Africa

2021 ◽  
Author(s):  
Sophie Witter ◽  
Maria van der Merwe ◽  
Rhian Twine ◽  
Denny Mabetha ◽  
Jennifer Hove ◽  
...  
Keyword(s):  
South Africa ◽  
Health System ◽  
Participant Observation ◽  
Health Sector ◽  
Research Process ◽  
Personal Factors ◽  
Decision Space ◽  
Mpumalanga Province ◽  
Local Leadership ◽  
Using Data

Abstract Background Decentralised and evidence-informed health systems rely on managers and practitioners at all levels having sufficient ‘decision space’ to make timely locally informed and locally relevant decisions. Our objectives were to: (a) understand decision spaces in terms of constraints and enablers (using a framework focused on authority, accountability and capacity and the interrelationships between these domains); and (b) outline opportunities through which to expand and enhance them in an understudied rural context in South Africa. Methods This study examined decision spaces within Mpumalanga Province, using data and insights generated through a participatory action research process with local communities and health system stakeholders since 2015, which was triangulated with published documents and research team participant observation to produce findings on the three core domains at three levels of the health system. Results There is significant capacity in the system, which is delivering on many of its goals, with areas of high achievement. While lines of authority are generally well-defined, personal networks take on an important dimension in how stakeholders can act. This is expressed through marked ingenuity and a range of informal coping strategies built on local relationships. There are constraints in terms of limited formal external accountability to communities and internal accountability which is weak in places for individuals and focused more on meeting performance targets set at higher levels and less on enabling effective local leadership. More generally, political and personal factors are clearly identified at higher levels of the system, whereas at sub-district and facility levels, the dominant theme was constrained capacity, affecting all health system components. Conclusions Decision space can be opened up through supporting leadership and organisational culture changes. In this scenario, the real resources in the system, which are human, technical and financial, can be empowered to realise potential more fully. The article adds to existing literature by applying a decision space lens at multiple levels of a decentralised health care system, focusing on a broad range of capacities, and providing future directions to support and expand existing capacity.

scholarly journals Seven Decades of Primary Healthcare during Various Development Plans in Iran: A Historical Review

2020 ◽  
Vol 23 (5) ◽  
pp. 338-352 ◽  
Author(s):  
Leila Doshmangir ◽  
Esmaeil Moshiri ◽  
Farshad Farzadfar
Keyword(s):  
Health System ◽  
Primary Healthcare ◽  
Health Sector ◽  
Historical Review ◽  
The People ◽  
Before And After ◽  
History Of ◽  
Development Plans ◽  
Using Data ◽  
Iranian Health System

Objective: To explore historically primary healthcare (PHC) development in Iran in the light of development plans before and after the Islamic Revolution. The results of this study can be used to outline the future of PHC in the Iranian health system. Methods: We conducted a retrospective analysis of the PHC development in the Iranian health system using data from relevant published and unpublished policy documents. The literature was retrieved and reviewed on the basis of predetermined inclusion criteria with no language or date restriction. The data were integrated and analyzed using content analysis. Results: During various upstream development plans, the attitude of the policy makers to PHC has been very different, resulting in fundamental differences in addressing such an important issue and the consequent outcomes. In the aftermath of Iran’s revolution, due to more understanding of PHC services importance and the principal slogans of the revolution to pay attention to villagers and vulnerable people, health policymakers paid more attention to PHC, which was not evident in previous periods. Conclusions: Despite considerable achievements in PHC, the history of PHC in Iran indicates frequent changes in planning and health provision structure. This suggests that the challenges facing the health sector today, the evolving needs and demands of the people, and population changes necessitate reinforcement and reform in the structure of the current PHC network as the main mission of Iran’s Ministry of Health.

scholarly journals Pandemia se Combate em Rede! Desafios da COVID-19 no Nordeste do Brasil

2021 ◽  
Vol 25 (spe) ◽  
Author(s):  
Raphael Jesus Campos de Andrade ◽  
José Milton de Sousa-Filho ◽  
Fátima Evaneide Barbosa de Almeida ◽  
Samuel Façanha Câmara
Keyword(s):  
Health System ◽  
Business Strategy ◽  
Participant Observation ◽  
Health Sector ◽  
Secondary Data ◽  
Industrial Sector ◽  
Northeastern Brazil ◽  
Leadership Process ◽  
Business Administration Students ◽  
Cooperation Network

ABSTRACT With the occurrence of the COVID-19 pandemic in 2020, it became imperative to adopt emergency measures to prevent a crisis in the health system in northeastern Brazil. In this context, Miguel Bastos, manager of Sistema Indústria, a class entity in the northeastern industrial sector, dedicated all his efforts to coordinate an emerging network of institutions involved in research, development, innovation, manufacturing, and maintenance of products demanded by a health system. Thus, this teaching case aims to allow students to understand the context of a cooperation network created to meet the needs of the health sector in combating the pandemic of COVID-19. Given the difficulties inherent in a leadership process involving seven different institutions, how should the protagonist organize this network to meet the expected demands? The case has as target audience undergraduate Business Administration students, as well as lato sensu graduate courses, in subjects such as Business Strategy, Cooperation Networks, Public-Private Partnerships, among others that address the themes proposed in the present case. It is noteworthy that authors collected data from participant observation, secondary data, and interviews. The characters are real, but the names are fictitious.

scholarly journals Psychological ailments and their treatment protocols: a case study of Swati traditional healers in Mpumalanga Province, South Africa

2021 ◽  
Vol 21 (2) ◽  
pp. 884-895
Author(s):  
Anastasia Ngobe ◽  
Sebua Semenya ◽  
Tholene Sodi
Keyword(s):  
South Africa ◽  
Mental Illness ◽  
South African ◽  
Health Sector ◽  
Treatment Protocol ◽  
Traditional Healers ◽  
Integrated Treatment ◽  
Structured Interviews ◽  
Treatment Protocols ◽  
Mpumalanga Province

Background: Evidence suggests that South African traditional healers (THs) treat various mental complaints. However, there is little literature on Swati THs’ accounts on this subject. The current study therefore, sought to address this gap. Methods: Data was gathered using qualitative research methods, namely semi-structured interviews with 10 purposely sampled Swati THs practicing in the Kanyamazane peri-urban township (Mpumalanga Province, South Africa). Data was thematically analysed. Results: Results showed that THs treat seven psychological aliments, viz. adjustment disorders, depression, mental illness due to ancestral calling, mental illness due to bewitchment, mental illness due to breaking of taboos, psychotic disturbance and substance induced mental illness. Generally, an integrated treatment protocol was utilised by THs to treat and manage these disorders. Most of these procedures are acceptable from either folkloric or scientific viewpoint, and have demonstrat- ed certain level of efficacy in treating mental illness. Conclusion: Taken together, the evidence presented indicates that Swati THs use different traditional methods to manage various mental complaints. In doing so, they carry a large share of the community caseload for mental health, whilst admit- ting patients in their homes for extended periods of time, and also referring some (patients) for additional care within the Western health sector. Keywords: Mental illness; Mpumalanga; Swati; traditional healers; treatment methods; psychological ailments.

scholarly journals Pandemic Fights in a Network! COVID-19 Challenges in Northeast Brazil

2021 ◽  
Vol 25 (spe) ◽  
Author(s):  
Raphael Jesus Campos de Andrade ◽  
José Milton de Sousa-Filho ◽  
Fátima Evaneide Barbosa de Almeida ◽  
Samuel Façanha Câmara
Keyword(s):  
Health System ◽  
Business Strategy ◽  
Participant Observation ◽  
Health Sector ◽  
Secondary Data ◽  
Industrial Sector ◽  
Northeastern Brazil ◽  
Leadership Process ◽  
Business Administration Students ◽  
Cooperation Network

ABSTRACT With the occurrence of the COVID-19 pandemic in 2020, it became imperative to adopt emergency measures to prevent a crisis in the health system in northeastern Brazil. In this context, Miguel Bastos, manager of Sistema Indústria, a class entity in the northeastern industrial sector, dedicated all his efforts to coordinate an emerging network of institutions involved in research, development, innovation, manufacturing, and maintenance of products demanded by a health system. Thus, this teaching case aims to allow students to understand the context of a cooperation network created to meet the needs of the health sector in combating the pandemic of COVID-19. Given the difficulties inherent in a leadership process involving seven different institutions, how should the protagonist organize this network to meet the expected demands? The case has as target audience undergraduate Business Administration students, as well as lato sensu graduate courses, in subjects such as Business Strategy, Cooperation Networks, Public-Private Partnerships, among others that address the themes proposed in the present case. It is noteworthy that authors collected data from participant observation, secondary data, and interviews. The characters are real, but the names are fictitious.

South African health decentralisation: requiring contextually intelligent leaders

2017 ◽  
Vol 7 (4) ◽  
pp. 1-23
Author(s):  
Ellenore Meyer ◽  
Leena Thomas ◽  
Selma Smith ◽  
Caren Scheepers
Keyword(s):  
Public Health ◽  
South Africa ◽  
Health Care ◽  
Decision Making ◽  
Health System ◽  
South African ◽  
Decision Space ◽  
Content Type ◽  
African Health ◽  
South African Health

Subject area Public Health; Leadership; Organisational Development; Organisational Behaviour; Public Administration Management. Study level/applicability Postgraduate level for honours or masters programmes in courses on public health; executive leadership and management programmes; MBA level. Case overview The case unpacks decentralisation as a means to promote and improve local decision-making and accountability through community participation and engagements. Ayanda Nkele was a programme manager in a health district in South Africa. He was faced with many challenges when trying to implement his programme, most of which were related to local authority, responsibilities and decision-making abilities at his level. This case describes briefly the South African health system. and how it functions. It describes the proposed changes to the health system and its transformation towards Universal Health Coverage. The decision space analysis as discussed in the case illustrates the types of decentralisation in the country and how this also applies to Nkele’s level. Expected learning outcomes Understanding the concepts and principles of decentralisation within the context of strengthening district health services, the re-engineering of primary health care (PHC) and rolling out a National Health Insurance in South Africa. Applying the “decision space” approach to analyse the extent of decentralisation. Grasping the requirement of leaders to be “contextually intelligent” and identify the important contextual variables to take into account when analysing public health care. Supplementary materials Teaching Notes are available for educators only. Please contact your library to gain login details or email [email protected] to request teaching notes. Subject code CSS 7: Management Science.

Favelas and townships: place making, everyday racialization, and the postracial

2019 ◽  
Vol 39 (11/12) ◽  
pp. 962-974
Author(s):  
Sergio Henrique Rocha Franco
Keyword(s):  
South Africa ◽  
Social Dynamics ◽  
Participant Observation ◽  
Comparative Approach ◽  
Equal Rights ◽  
Place Making ◽  
Content Type ◽  
Racial Democracy ◽  
Using Data ◽  
Racial Discourses

Purpose The purpose of this paper is to indicate how place making and belonging are still largely governed by race in Brazil and South Africa. As such, it engages with debates about the postracial informed by the study of two urban settings that are discernible by their relationship with race issues: Rio de Janeiro’s favelas and Johannesburg’s townships. Design/methodology/approach The study provides a brief account of post-racial discourses in each country: Brazilian racial democracy and South Africa’s self-imagination as rainbow nation. Subsequently, these two major national self-understandings are probed using data gathered in the fieldwork (participant observation and in-depth interviews) carried out in Rio de Janeiro’s favelas and Johannesburg’s townships between 2013 and 2015. Findings The main accomplishment of the study is to approach debates about senses of place, understood here as place making and belonging, from the everyday experiences of favela and township inhabitants. The study suggests discrepancies between the racialized senses of place in Brazilian and South African urban milieus and any sort of post-racial rhetoric. Despite the existence of norms and institutions promoting equal rights of citizenship in Brazil and South Africa, place making is still largely encumbered by the legacy of racial domination in both countries. Originality/value By adding new evidence to the research on everyday racism, the study explores the mutual influences between senses of place and the persistent patterns of racial segregation in two urban contexts of the global South. Beyond this, it offers a comparative approach that connects micro-level social dynamics and macro-level discourses.

scholarly journals Impact of financial management centralisation in a health system under austerity: a qualitative study from South Africa

2020 ◽  
Vol 5 (10) ◽  
pp. e003524
Author(s):  
Jodi Wishnia ◽  
Jane Goudge
Keyword(s):  
Decision Making ◽  
Health System ◽  
Financial Management ◽  
Participant Observation ◽  
Health Sector ◽  
Management Style ◽  
Primary Data ◽  
Health Coverage ◽  
Large Power ◽  
The Impact

IntroductionInternational calls for universal health coverage (UHC) have led many countries to implement health sector reforms, however, since the 2008 global recession, economic growth has slowed in many lower-income and middle-income countries. In a renewed interest in public financial management (PFM), international organisations have emphasised the importance of giving spending control to those responsible for healthcare. However, centralisation is a common response when there is a need to cut expenditure due to a reduced budget; yet failure to decentralise often hampers the achievement of important goals. This paper examines the effect of centralising financial decision-making on the functioning of the South African health system.MethodsWe used a case study design with an ethnographic approach. Primary data collection was conducted through participant-observation and semistructured interviews, over 1 year. Member checking was conducted.ResultsNew management implemented centralisation due to a reduced budget, a history of financial mismanagement, the punitive regulatory environment financial managers face, and their fear of poor audit outcomes. The reform, together with an authoritarian management style to ensure compliance, created a large power distance between financial and clinical managers. District managers felt that there was poor communication about the reform and that decision-making was opaque. This lowered commitment to the reform, even for those who thought it was necessary. It also reduced communal action, creating an individualistic environment. The authoritarian management style, and the impact of centralisation on service delivery, negatively affected planning and decision making, impairing organisational functioning.ConclusionAs public health systems become even more financially constrained, recognising how PFM reforms can influence organisational culture, and how the negative effects can be mitigated, is of international importance. We highlight the importance of a participatory culture that encourages shared decision making and coproduction, particularly as countries grapple with how to achieve UHC with limited funds.

The Role of Archives on the Incorporation of the Former Kangwane Homeland to Mpumalanga Province

2018 ◽  
Vol 47 (2) ◽  
Author(s):  
Nkholedzeni Sidney Netshakhuma
Keyword(s):  
South Africa ◽  
Qualitative Methodology ◽  
Management Policy ◽  
Records Management ◽  
Record Keeping ◽  
Mpumalanga Province ◽  
Specific Objective ◽  
National Archives ◽  
And Control

This study was conceptualised in order to assess the strategies used to incorporate the homeland of KaNgwane into Mpumalanga province after the cessation of apartheid in 1994. The specific objective of the study was to investigate the compliance of records and archives with the National Archives and Records Service of South Africa Act (Act No 43 of 1996), during the incorporation of the homeland of KaNgwane into Mpumalanga. The study adopted a qualitative methodology through document analysis, interviews and observations. The key findings revealed that the archives of the former homeland of Kangwane were not aligned with the requirements of the National Archives and Records Service of South Africa Act (Act No.43 of 1996.) Institutions seem to lack experience when it comes to the challenges of storing records and implementing arrangement and control systems. The frequent lack of a records management policy and few to no staff with record-keeping and archival backgrounds was also a concern. A shortage of space to store records safely was also one of the major issues that the study uncovered. There appears to be no concerted effort to retain important historical records. Many records are stored in several different locations in government buildings.  I conclude that archives play an essential role to the nation as the institutional memory.

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