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Jika iMfundo, with its particular focus on curriculum coverage, is an intervention for systemic education change. In this paper we focus on the extent to which Heads of Departments (HoDs) are able to play an adaptive leadership role in supporting the teachers in their departments. We report on data generated from interviews with HODs in fifteen KwaZulu-Natal schools that had been part of the Jika iMfundo intervention from 2015 to 2017. While Jika iMfundo's aim is to shift HODs' leadership practices from being based on technical compliance to the achievement of a more developmental and supportive role, our findings show that the majority of HODs were not able to do this because of their heavy workloads and overwhelming administrative responsibilities. We argue that the theory of change based on the Programme for Improving Learning Outcomes (PILO) has unrealistic expectations of HODs as key levers of change for curriculum coverage and, furthermore, that this theory does not take into account the realities and variations of resourcing in different school contexts.

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This Article focuses on uterine health care and women's participation in decisions to undergo hysterectomy. While hysterectomy is one of the most commonly performed surgical procedures, not much is known about how women make decisions to undergo such surgery. In South Africa there are health policies that aim to, among other things, increase the participation of patients in decision-making about their health. The Quality in Health Care for South Africa Policy (DoH, 2007) is one such policy, and aims to increase patients' participation and the dignity afforded to them. A sample of women who had undergone hysterectomy because of fibroids was interviewed to gain insight into their participation in deciding to undergo a hysterectomy, and on their experiences of this surgery. The women indicated that the hysterectomy relieved them of the physical pain they suffered before the surgery. However, they expressed frustration because of the lack of adequate information about the procedure as well as a lack of support before and after surgery. They indicated that although they were informed that this was a life-saving procedure, they were not informed about alternatives available to them besides the hysterectomy. They were also not informed about the surgery's possible damaging after effects. These findings indicate that there is a need for health practitioners to ensure that women are given adequate information about available options and possible side effects of the surgery. The findings also reveal that the health care system needs to provide counselling and support, particularly for African women, who may have unique socio-cultural needs. keywordsHysterectomy, decision making, information, reproductive health, choice

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