Implementing the ideal hospital programme in two rural district hospitals in the West Coast District, Western Cape Province, South Africa: A qualitative study of staff perspectives

Abstract

South Africa's constitution guarantees the right to health and embeds regulations to ensure the delivery of quality healthcare. The National Ministry of Health proposed the National Health Insurance (NHI) Bill in 2012 to support universal health coverage. The National Department of Health established the Office of Health Standards Compliance in 2013 to enforce compliance with the National Core Standards and to provide high-quality healthcare, even though the National Core Standards were promulgated only in 2015. Inspection tools based on the National Core Standards were finalized only in 2018. The Ideal Hospital Programme was introduced in 2018 with its own set of tools to enhance hospital service delivery and to prepare for the implementation of NHI and compliance with the Office of Health Standards Compliance assessments. The COVID-19 pandemic disrupted the Ideal Hospital Programme, resulting in slow progress and poor assessment results. None of the seven district hospitals in the Western Cape's West Coast District met the requirements of the Ideal Hospital Programme during the 2023-24 self-assessments, with outcomes for all seven district hospitals being unsatisfactory, highlighting implementation and sustainability challenges. Concerns about sustainability and the lack of research to support learning and improvement for the Ideal Hospital Programme were raised in a workshop held in June 2024. This situation prompted a research examination of the Ideal Hospital Programme's current state in the West Coast District of the Western Cape and the experiences of staff implementing the programme.