Schneider, HelenJassat, Waasila2023-01-252024-11-072023-01-252024-11-072022https://hdl.handle.net/10566/19200Philosophiae Doctor - PhDSouth Africa is one of the high burden countries for drug-resistant tuberculosis (DR-TB) globally. A policy supporting decentralised DR-TB treatment provision was introduced in 2011 but to date implementation has been suboptimal with variable coverage and quality. This thesis opens the ‘black box’ explaining sub-national policy implementation of DR-TB decentralisation in two provinces of South Africa, Western Cape and KwaZulu-Natal. The thesis is grounded in the field of policy analysis and adopts the methodological approach of a qualitative multiple case study, comparing 15 embedded district and subdistrict cases in the two provinces, through data collected in 94 in-depth interviews, document reviews, and observations. Applying Walt and Gilson’s Policy Analysis Triangle framework, the case studies of DR-TB in the two provinces revealed how aspects of actors’ engagement with the policy instrument, influenced by organisational dynamics and the wider context, resulted in varying effectiveness of policy implementation.enTuberculosisPublic healthHealth systemSouth AfricaUniversity of the Western Cape