Improving public health sector service delivery in the Free State, South Africa: development of a provincial intervention model

Abstract

Background Public health sector service delivery challenges leading to poor population health outcomes have been observed in the Free State province of South Africa for the past decade. A multi-method situation appraisal of the different functional domains revealed serious health system deficiencies and operational defects, notably fragmentation of healthcare programmes and frontline services, as well as challenges related to governance, accountability and human resources for health. It was therefore necessary to develop a system-wide intervention to comprehensively address defects in the operation of the public health system and its major components. Methods This study describes the development of the ‘Health Systems Governance & Accountability’ (HSGA) intervention model by the Free State Department of Health (FSDoH) in collaboration with the community and other stakeholders following a participatory action approach. Documented information collected during routine management processes were reviewed for this paper. Starting in March 2013, the development of the HSGA intervention model and the concomitant application of Kaplan and Norton’s (1992) Balanced Scorecard performance measurement tool was informed by the World Health Organization’s (2007) conceptual framework for health system strengthening and reform comprised of six health system ‘building blocks.’ The multiple and overlapping processes and actions to develop the intervention are described according to the four steps in Kaplan et al.’s (2013) systems approach to health systems strengthening: (i) problem identification, (ii) description, (iii) alteration and (iv) implementation. Results The finalisation of the HSGA intervention model before end-2013 was a prelude to the development of the FSDoH’s Strategic Transformation Plan 2015–2030. The HSGA intervention model was used as a tool to implement and integrate the Plan’s programmes moving forward with a consistent focus on the six building blocks for health systems strengthening and the all-important linkages between them. Conclusion The model was developed to address fragmentation and improve public health service delivery by the provincial health department. In January 2016, the intervention model became an official departmental policy, meaning that it was approved for implementation, compliance, monitoring and reporting, and became the guiding framework for health systems strengthening and transform in the Free State.

Monitoring and Evaluating Electronic Health Records Systems in Public and Private Hospitals in the Ethekwini Area, Kwazulu Natal, South Africa

“…This lack of monitoring and evaluation mechanisms can lead to an erosion in care quality and a drop in patient satisfaction, especially in public hospitals. Furthermore, the lack of a defined process has hindered the development of a strategy to address the existing issues (Malakoane et al 2022;Maphumulo;Bhengu 2019). The study aims to establish guidelines for monitoring and evaluating the effectiveness of electronic health record management in improving healthcare service delivery.…”

Health managers and community representatives’ views of a system-wide intervention to strengthen public healthcare in the Free State, South Africa

“…The considered intervention model was an integrated approach to health service delivery in the Free State province starting from the community up through all levels to the central health services. It was designed to improve health system performance by effectively supporting the interaction between disease-specific programmes, complemented by a precise routine assessment method, i.e., the BSC performance-monitoring tool 44 – 45 . This study aimed to assess HMs and CRs' views on whether public health service integration had indeed been enhanced and if the integration of the roles and responsibilities of HMs and CRs, as well as attempts to enhance the Health Information Management System, had improved ‘whole-system’ operations.…”

Navigating the healthcare system in Nairobi City County: perspectives and experiences in the utilization of oral healthcare by caregivers of children with HIV/AIDS

“…Six building blocks were identified as contributing to the strengthening of health systems in different ways; i) service delivery, ii) health workforce, iii) health information systems, iv)access to essential medicines, v)financing, and vi) leadership/governance. For many researchers, the framework evidently focuses on health sector actions while failing to deal with substantial and dynamic links and interactions that exist across each components; such as, the underlying social and economic determinants of the consumers, or even the problems of fragmentation and ineffective performance of public health systems in LMICs [19][20][21]. To this end, information is required, but gaps exist in data availability and quality.…”