Background There is overwhelming evidence that the quality of health care in South Africa has been compromised by various challenges that impact negatively on healthcare quality. Improvement in quality care means fewer errors, reduced delays in care delivery, improvement in efficiency, increased market share and lower cost. Decline in quality health care has caused the public to lose trust in the healthcare system in South Africa. Objectives The purpose of this study was to identify challenges that are being incurred in practice that compromise quality in the healthcare sector, including strategies employed by government to improve the quality of health delivery. Method Literature search included the following computer-assisted databases and bibliographies: Medline (Medical Literature Online), EBSCOhost, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google, Google Scholar and ScienceDirect. Furthermore, websites were used to source policy documents of organisations such as the National Department of Health in South Africa and the World Health Organization. Results Seventy-four articles were selected from 1366 retrieved. These articles quantify problems facing quality care delivery and strategies used to improve the healthcare system in South Africa. Conclusion The findings revealed that there were many quality improvement programmes that had been initiated, adapted, modified and then tested but did not produce the required level of quality service delivery as desired. As a result, the Government of South Africa has a challenge to ensure that implementation of National Core Standards will deliver the desired health outcomes, because achieving a lasting quality improvement system in health care seems to be an arduous challenge.

The National Department of Health in South Africa has introduced the National Core Standards (NCS) tool to improve the quality of healthcare delivery in all public healthcare institutions. Knowledge of the NCS tool is essential among healthcare providers. This study investigated the level of knowledge on NCS and how the NCS tool was communicated among professional nurses. This was a cross-sectional survey study. Purposive sampling technique was used to select hospitals that only offered tertiary services in KwaZulu-Natal. Six strata of departments were selected using simple stratified sampling. The population of professional nurses in the selected hospitals was 3 050. Systematic random sampling was used to recruit 543 participants. The collected data were analysed using SPSS version 25. The study showed that only 16 (3.7%) respondents had knowledge about NCS, using McDonald’s standard of learning outcome measured criteria regarding the NCS tool. The Pearson correlation coefficient between the communication and knowledge was r = 0.055. The results revealed that although the communication scores for the respondents were high their knowledge scores remained low. This study concluded that there is a lack of knowledge regarding the NCS tool and therefore healthcare institutions need to commit themselves to the training of professional nurses regarding the NCS tool. The findings suggest that healthcare institutions implement the allocation of incentives for nurses that attend the workshops for NCS.

Globally, all healthcare systems face challenges in improving the quality of healthcare services delivery. In South Africa, the National Department of Health introduced the National Core Standards (NCS) tool in 2011 as affirmation of what is predicted to deliver decent, safe and high-quality care in healthcare establishments. The study presented in this paper aimed to determine unit managers’ perceptions of the implementation of the NCS in tertiary hospitals in KwaZulu-Natal, South Africa. This was a cross-sectional, descriptive survey. A purposive sampling technique was used to select hospitals offering secondary and tertiary services in KwaZulu-Natal. A census method was used to recruit all unit managers in the study. A census method is an attempt to list all elements or to use every unit in a group and to measure one or more characteristics of those elements. Out of the 169 population of unit managers counted in these hospitals, only 95 participated in the study. The collected data were analysed using SPSS Statistics version 25. The study showed that the participants’ perceptions were positive about the availability of material resources. However, a shortage of human resources in terms of numbers, skills, and skills mix was noted. The results also revealed that the participants’ perceptions of the availability of a positive working environment were negative. This study recommends that the healthcare authorities develop a strategic approach to manage scarce human resources by attracting, sourcing, selecting, training, developing, and retaining healthcare workers. This includes creating a positive working environment to promote staff retention.

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