Background: Focus for improved malaria programme performance is often placed on the technical challenges, while operational issues are neglected. Many of the operational challenges that inhibit malaria programme effectiveness can be addressed by improving communication and coordination, increasing accountability, maintaining motivation, providing adequate training and supervision, and removing bureaucratic silos. Methods: A programme of work was piloted in Zimbabwe with one malaria eliminating province, Matabeleland South in 2016-2017, and scaled up to include two other provinces, Matabeleland North and Midlands, in 2017-2018. The intervention included participatory, organization development and quality improvement methods. Results: Workshop participants in Matabeleland South reported an improvement in data management. In Matabeleland North, motivation among nurses improved as they gained confidence in case management from training, and overall staff morale improved. There was also an improvement in data quality and data sharing. In Midlands, the poorly performing district was motivated to improve, and both participating districts became more goal-oriented. They also became more focused on monitoring their data regularly. Participants from all provinces reported having gained skills in listening, communicating, facilitating discussions, and making presentations. Participation in the intervention changed the mindset of malaria programme staff, increasing ownership and accountability, and empowering them to identify and solve problems, make decisions, and act within their sphere of influence, elevating challenges when appropriate. Conclusions: This pilot demonstrates that a participatory, organization development and quality improvement approach has broad ranging effects, including improving local delivery of interventions, tailoring strategies to target specific populations, finding efficiencies in the system that could not be found using the traditional top-down approach, and improving motivation and communication between different cadres of health workers. Scale-up of this simple model can be achieved and benefits sustained over time if the process is imbedded into the programme with the training of health staff who can serve as management improvement coaches. Methods to improve operational performance that are scalable at the district level are urgently needed: this approach is a possible tactic that can significantly contribute to the achievement of global malaria eradication goals.

BackgroundFocus for improved malaria program performance is often placed on the technical challenges, while operational issues are neglected. Many of the operational challenges that inhibit malaria program effectiveness can be addressed by improving communication and coordination, increasing accountability, maintaining motivation, providing adequate training and supervision, and removing bureaucratic silos. MethodsIn collaboration with the Zimbabwe Ministry of Health and Child Care (MoHCC), University of California San Francisco (UCSF), University of West of England (UWE), Clinton Health Access Initiative (CHAI) Zimbabwe, and organization development consultants from South Africa and Zimbabwe, a program of work was piloted in Zimbabwe starting with one malaria eliminating province, Matabeleland South in 2016-2017, and scaled up to include two other provinces, Matabeleland North and Midlands, in 2017-2018. The intervention included participatory, organization development and quality improvement methods.ResultsWorkshop participants in Matabeleland South reported an improvement in data management, with the development of a data collection tool, the initiation of data reporting from district to province on a weekly basis, and the establishment of a data focal point in each district. In Matabeleland North, motivation among nurses improved as they gained confidence in case management from training, and overall staff morale was impacted positively. There was also an improvement in data quality and the frequency in which data was shared via weekly bulletins. In Midlands, the poorly performing district was motivated to improve, and both participating districts became more goal-oriented. They also became more focused on monitoring their data regularly and learned how to develop indicators to measure the process improvement changes they were making. Participants from all provinces reported having a better appreciation of the value of communication, teamwork, planning, continuous monitoring of data, and adjustment of work plans and gained skills in listening, communicating, facilitating discussions, and making presentations. Participation in the intervention changed the mindset of malaria program staff, increasing ownership and accountability, and empowering them to identify and solve problems, make decisions, and act within their sphere of influence, elevating challenges when appropriate. ConclusionsThis pilot demonstrates that a participatory, organization development and quality improvement approach has broad ranging effects, including inter alia: improving local delivery of interventions, tailoring strategies to target specific populations, finding efficiencies in the system that could not be found using the traditional top-down approach, and improving motivation and communication between different cadres of health workers. Scale-up of this simple model can be achieved and benefits sustained over time if the process is imbedded into the program with the training of health staff who can serve as management improvement coaches. Methods to improve operational performance that are scalable at the district level are urgently needed: a participatory, organization development and quality improvement approach is a possible tactic that can significantly contribute to the achievement of global malaria eradication goals.

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Background Focus for improved malaria programme performance is often placed on the technical challenges, while operational issues are neglected. Many of the operational challenges that inhibit malaria programme effectiveness can be addressed by improving communication and coordination, increasing accountability, maintaining motivation, providing adequate training and supervision, and removing bureaucratic silos. Methods A programme of work was piloted in Zimbabwe with one malaria eliminating province, Matabeleland South in 2016-2017, and scaled up to include two other provinces, Matabeleland North and Midlands, in 2017-2018. The intervention included participatory, organization development and quality improvement methods. Results Workshop participants in Matabeleland South reported an improvement in data management. In Matabeleland North, motivation among nurses improved as they gained confidence in case management from training, and overall staff morale improved. There was also an improvement in data quality and data sharing. In Midlands, the poorly performing district was motivated to improve, and both participating districts became more goal-oriented. They also became more focused on monitoring their data regularly. Participants from all provinces reported having gained skills in listening, communicating, facilitating discussions, and making presentations. Participation in the intervention changed the mindset of malaria programme staff, increasing ownership and accountability, and empowering them to identify and solve problems, make decisions, and act within their sphere of influence, elevating challenges when appropriate. Conclusions This pilot demonstrates that a participatory, organization development and quality improvement approach has broad ranging effects, including improving local delivery of interventions, tailoring strategies to target specific populations, finding efficiencies in the system that could not be found using the traditional top-down approach, and improving motivation and communication between different cadres of health workers. Scale-up of this simple model can be achieved and benefits sustained over time if the process is imbedded into the programme with the training of health staff who can serve as management improvement coaches. Methods to improve operational performance that are scalable at the district level are urgently needed: this approach is a possible tactic that can significantly contribute to the achievement of global malaria eradication goals.

<strong>Orientation: </strong> The intractability of public service delivery and a polarised societal landscape heighten anxiety and reinforce a propensity for public service organisations to be used for defensive purposes.<p><strong>Research purpose:</strong> This article employs social defense theory to explore manifestations of anxiety and defense within South African public service organisations.</p><p><strong>Motivation for the study:</strong> Dominant discourse on public service institutions over-relies on political, sociological and public administration theories and tends to ignore psychosocial explanations. Further, whilst the psychodynamics of social service work are generally understood, the unconscious dynamics of generic public service work remain under-theorised. <strong></strong></p><p><strong>Research design, approach and method:</strong> This conceptual article draws on my personal observations as a reflective citizen and experiences as a consultant to government departments.</p><p><strong>Main findings:</strong> Herein, an argument is advanced that the deployment of ill-qualified party loyalists to key positions in the public service is perverse: it serves as a collective defense against the impossible aspects of the task at hand. The appointees, in turn, deploy organisational processes to defend against feelings of incompetence and the inevitability of failure. This practice, coupled with acute resource constraints, sets up front line staff for scapegoating.</p><p><strong>Practical/managerial implications:</strong> An appreciation of the multiple meanings of public service work and the defensive role played by public institutions stands to inform purposeful change towards sustainable public service organisational practice.</p><p><strong>Contribution/value-add:</strong> The discussion seeks to contribute to attempts that employ systems psychodynamics to make sense of anxiety and defense within organisations in general and public service institutions in particular.</p><p><strong>How to cite this article:</strong><br /> Mnguni, P.P. (2012). Deploying culture as a defence against incompetence: The unconscious dynamics of public service work. <em>SA Journal of Industrial Psychology/SA Tydskrif vir Bedryfsielkunde, 38</em>(2), Art. #1000, 9 pages. http://dx.doi.org/10.4102/sajip.v38i2.1000</p>