Browsing by Author "Padayachee, Thesandree"

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    Progress in the establishment of ward based outreach teams: experiences in the North West Province
    (Health Systems Trust, 2013) Padayachee, Thesandree; Chetty, Natasha; Matse, Muzi; Mampe, Tumelo; Schneider, Helen
    This chapter briefly describes the implementation of the Ward-based Outreach Teams (WBOTs) in the North West Province. The authors then highlight some of the findings of a rapid assessment of provincial and district implementation of Ward-based Outreach Teams conducted in the province during December 2012 and January 2013. The purpose of the chapter is to describe features of implementation that enabled the early uptake of the WBOTs in the province and to identify factors impacting on sustainable implementation that have relevance across the country. There has been a steady growth in roll-out and implementation of the PHC re- engineering strategy since 2011. By March 2014, 227 WBOTs (involving 1 643 community health workers and 201 team leaders) were functioning across the province. Implementation strategies included the establishment of a provincial task team, planning which was informed by a number of data-gathering exercises, a piloting process, implementation of a monitoring and evaluation system, development of supportive partnerships, and training of teams and team leaders. The rapid assessment found high levels of knowledge and ownership of the strategy across the province, but also concerns around its future. Based on the North West experience, the authors draw out a set of factors which will influence the sustainability of the WBOT strategy across the country. These strategies include making provision for: adequate financing, evidence-informed planning and implementation, provincial and district governance, communication and dialogue, appropriate partnerships and operational research on WBOTs.
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    Whole-system change: case study of factors facilitating early implementation of a primary health care reform in a South African province
    (BioMed Central, 2014) Schneider, Helen; English, Rene; Tabana, Hanani; Padayachee, Thesandree; Orgill, Marsha
    BACKGROUND: Whole-system interventions are those that entail system wide changes in goals, service delivery arrangements and relationships between actors, requiring approaches to implementation that go beyond projects or programmes. METHODS: Drawing on concepts from complexity theory, this paper describes the catalysts to implementation of a whole-system intervention in the North West Province of South Africa. This province was an early adopter of a national primary health care (PHC) strategy that included the establishment of PHC outreach teams based on generalist community health workers. We interviewed a cross section of provincial actors, from senior to frontline, observed processes and reviewed secondary data, to construct a descriptive-explanatory case study of early implementation of the PHC outreach team strategy and the factors facilitating this in the province. RESULTS: Implementation of the PHC outreach team strategy was characterised by the following features: 1) A favourable provincial context of a well established district and sub-district health system and long standing values in support of PHC; 2) The forging of a collective vision for the new strategy that built on prior history and values and that led to distributed leadership and ownership of the new policy; 3) An implementation strategy that ensured alignment of systems (information, human resources) and appropriate sequencing of activities (planning, training, piloting, household campaigns); 4) The privileging of ‘community dialogues’ and local manager participation in the early phases; 5) The establishment of special implementation structures: a PHC Task Team (chaired by a senior provincial manager) to enable feedback and ensure accountability, and an NGO partnership that provided flexible support for implementation. CONCLUSIONS: These features resonate with the deliberative, multi-level and context sensitive approaches described as the “simple rules” of successful PHC system change in other settings. Although implementation was not without tensions and weaknesses, particularly at the front-line of the PHC system, the case study highlights how a collective vision can facilitate commitment to and engagement with new policy in complex organisational environments. Successful adoption does not, however, guarantee sustained implementation at scale, and we consider the challenges to further information.