Health Policy and Systems

The HPS division hosts and supervises students at PhD, Masters and Diploma levels.

We convene the Master’s in Public Health (MPH), Health Systems Track – and the MPH courses: Introduction to Health Systems (HIS), Health Policy and Planning (HPP) and Health Systems Research and Evaluation (HSRE). We also convene the Post Graduate Diploma in Health Leadership, otherwise known as the Oliver Tambo Fellowship programme. The Diploma is the longest running health management training programme in South Africa and is a flagship programme in the Faculty of Health Sciences. We also welcome prospective PhD students addressing topics linked to our research interest and concerns, whilst being open to other ideas.

Finally, we welcome prospective PhD students addressing topics linked to our research interest and concerns, whilst being open to other ideas. Our current PhD students are listed in the 'Our Team' page.

MPH, specialising in Health Systems | Track Convenor:  Assoc Prof Jill Olivier

What our graduates do: Graduates of the PGDip in Health Leadership tend to take their learnings back into their workplaces. Our current graduates include regional and district health managers, hospital managers, clinical leaders, policy makers and advisors. The Diploma thus contributes significantly to the strengthening of health management and leadership in the South African Health System and beyond.

For more detailed information on the Diploma and intake information, please visit the Postgraduate Diploma in Health Leadership web page.

PhD Programme

PhD candidates are selected in the basis of the Division’s commitment to developing opportunities for emerging academics and researchers in the field of health policy and systems research. The topic and scope of the PhD will be further refined with candidates as part of the development of the PhD proposal. We welcome PhD applicants addressing our current areas of research interests, highlighted here.

The PhD experience is usually individualised – for example, some students work full time while doing a PhD part time, and others are full-time students. We also have students conducting PhDs relating to their work (e.g. within a Ministry of Health), and others are pursuing an academic career trajectory in the field of Health Policy and Systems Research. Whatever the configuration, our PhDs become part of the ‘Health Policy and Systems Family’, and are involved in the array of research, teaching, and mentorship offered through the Division. Please see the page on ‘Our Team’ to meet our current PhD candidates.

What our graduates do: A PhD with a health systems specialization provides opportunities at the highest levels – whether within the health system at senior leadership and advisory levels, or within an academic career trajectory.

For more detailed information on a PHD with a health systems specialization and intake information, please visit the PHD web page

As Health Policy and Systems Researchers, our work focuses on health systems as a whole - rather than particular health services, condition-specific programmes or health problems. Health system concerns address the complex range of factors that underpin service delivery. These include various system functions (e.g. leadership and governance, human resource development and management, financing and resource allocation, overarching models of care), as well health system software (e.g. values, norms, planning processes) and hardware (e.g. organisational structures, funding flows, personnel levels). Understanding how these factors interact and influence health system performance is an essential starting point for thinking about how to change and strengthen the system.

We also examine health policy processes and consider how to strengthen them. Health policies play an important role in complex health systems - shaping how health systems are experienced by those who use them. The complex political and social processes through which health issues are placed on the policy agenda, developed and implemented determine the extent to which policy goals are ultimately achieved.

Through our work we seek not only to understand health systems, but also to contribute actively and consciously to strengthening them. We understand health policy and system research - and researchers - to be important elements of the health system and seek to undertake research that fills real-world gaps in knowledge and is responsive to the concerns of policymakers, implementers and activists.

In our research, we a strive to be methodologically creative: drawing from a range of disciplines; conducting inter-disciplinary and trans-disciplinary research; using embedded research approaches to co-produce knowledge while simultaneously learning about and strengthening the health system.

Our research work can be categorised into the following overlapping broad themes:

1. Equitable health systems

All of our work is founded on a concern for social justice, and considers the role of health systems in promoting health and health care equity.

More specifically, in our research on non-communicable diseases and the social determinants of health, we explore how power, politics and vested interests shape who bears the burden of ill health, recognising the inequities inherent in this, and seeking to support health policy action and health system strengthening to address these inequities. In addition, we consider the role of the health system in implementing activities to support particular socially marginalised or vulnerable population groups. Also in this theme, is work that explores the relationship between citizens and the state, including how it is experienced by health system users. This includes work investigating how trust in the state influences the ability of the system to be responsive to the needs of those who use it, particularly marginalised and vulnerable populations.

2. Health system responsiveness

Health systems operate within constantly changing contexts and must meet a diverse range of health needs for the populations they serve. The capacity of health systems to continually innovate and evolve to meet population needs as they change over time, is referred to as health system responsiveness. To be responsive, health system actors, including decision-makers and front-line providers, need to have the freedom and capacity to be creative and flexible.

In addition, health systems ought to be sensitive to the preferences of those who use them, and the acceptability of health service delivery (referring to the extent to which the organisation and delivery of healthcare aligns with cultural and social preferences of users) is a key determinant of population health. Finally, this body of work includes the identification of bottom-up processes of accountability and innovation within health systems, and the factors that enable or constrain them.

3. Health system resilience

Since the Ebola epidemic in West Africa in 2014 attention has been paid globally to health systems resilience for the most part, defined as the ability of a health system to withstand shocks such as epidemics, large scale budget cuts or natural disasters.

In our research we have also specifically considered the chronic stressors that health systems must adapt to routinely from health worker absenteeism, to resource shortfalls, to organisational change and multiple top-down policy imperatives. We have developed the notion of everyday resilience to consider how health systems respond to such chronic stress, considering experience at facility and local area level, nested within broader sub-national or national structures. We judge that this everyday resilience is also important for resilience to acute shocks, like COVID-19.

4. Leadership and governance

Leadership and governance are important influences over health system functioning and performance. In this area of work we investigate the influence of leadership and management cultures and processes on health system functioning, including service delivery and management of human resources. Importantly, our educational and research activities interact in relation to leadership development. In addition, our work strives to support leaders and management within the South African and Western Cape health systems by identifying potential interventions to be implemented by health managers or civil society organisations to strengthen community engagement and promote accountability.

5. Health system actors and influences

We take a broad view of ‘health systems’ and recognise that systems are comprised of and driven by a diverse array of important actors. The analysis of the interactions between these actors is an important element of understanding and strengthening health systems. This area of work includes, for example, work on ‘street level bureaucrats’ within the public health system, as well as on Public Private Partnerships and other forms of engagement between state and non-state actors, and the significant role faith-based providers have played (and in many health systems continue to play) in delivering health    services alongside the state and for-profit providers).

We also recognise that many community actors play an informal but significant role in caring for children, the elderly and those who are sick, in creating and preserving healthy living environments, and in communicating health information to others.

6. Health policy and politics

The socio-political processes that determine which health and health system challenges are addressed by health policy interventions is an area of work that is under-studied and not well understood, particularly in LMICs. This body of work considers the influence of power, politics, actors, interests and ideas in shaping how health problems become policy issues, and how policies are framed, communicated and ultimately implemented. The work overlaps with our research around health system actors and influencers. In addition, in this area values and social justice goals play a critical role, and the work seeks specifically to analyse the social values, political factors and ideas influencing the development and implementation of health policy change.

7. HPSR research agenda, theories and methods

As HPSR is a relatively new field, the bounds of the field of study, as well as the most appropriate methodologies for exploring health systems, are constantly being refined and reiterated. As a Division, we seek to actively contribute to building and strengthening the field of HPSR by extending and strengthening inter-disciplinary perspectives and methodological approaches for HPSR. Accordingly, in our research we seek to influence the research agenda within HPSR, as well as identify and eliminate theoretical or conceptual gaps, and develop and refine new methodologies.

This body of work includes two research Readers (anthologies of papers, available here, a range of evidence synthesis approaches to bring together existing knowledge and facilitate engagement with it, and enable better use of HPSR in decision-making.

In addition, much of our field-building work uses theory on complex adaptive systems and systems-thinking. Because health systems are complex, context-dependent social systems, interventions regularly have unintended and unanticipated consequences, particularly over time. This area of work also, then, includes research that uses novel approaches to evaluate the effect of health system strengthening interventions over time and in different contexts, such as prospective tracking work and work using historical methods. 

As a division, our orientation to social responsiveness is that it is a ‘way of being’, purposive and deliberate, an overall orientation of the HPS Division and infused into all our work. At the core of our work is a commitment to supporting health system development for public value – including through reciprocal relationships with health system actors and civil society stakeholders.

The following initiatives/projects reflect some of the various dimensions of SR as espoused by the University:

1. Journal Club – see article here

The Western Cape (WC) HPSR Journal Club (JC) is an embedded HPSR hub that was established in 2012. The bi-monthly sessions are attended by provincial and local government health managers, as well as academics involved in education and research and researchers from other organizations. It is a space for collective sensemaking and knowledge mobilisation that draws on 'the tacit knowledge of experienced practitioners into the task of better understanding health policy and health systems, and how to strengthen policy implementation and system performance'.
 

2. Child Health Gauge 2019 – see report here

The South African Child Gauge is an annual publication of the Children’s Institute, University of Cape Town that tracks progress for South Africa’s children. It aims to make the latest research accessible to decision-makers, practitioners and civil society, in order to inform evidence- based policies and programmes for children and guide advocacy on behalf of, and with, children. In the 2019 edition special attention was paid to the health system challenges and opportunities for child health improvement.
 

3. Cape Town Together CAN – see article here

Cape Town Together, a network of self-organising neighbourhood-level groups known as Community Action Networks (CANs), emerged in response to the COVID-19 pandemic. From sharing information and resources, to setting up community kitchens, the network became an important part of the overall societal COVID-19 response.
 

4. NHI Library - can be found here

This online repository of NHI-related submissions, opinion pieces and policy documents is a collaboration between our division, CHEASI and the Health Justice Initiative (HJI).
 

5. Sex work and LGBTIQ+ rights and health research and advocacy

This area of advocacy and research work highlights the experiences of queer persons and sex workers in navigating health systems and services. This work is in collaboration with organisations such as Mothers for the Future, Sex Workers Education and Advocacy TaskForce (SWEAT), the Sexual and Reproductive Justice Coalition (SRJC) and the Triangle Project. This work connects to efforts to mobilise towards the decriminalisation of sex work to advance the rights and health of sex workers, with efforts to ensuring realisation of constitutional and human rights womxn, LGBTIQ+ persons, their partners, and families. Click here for more information.

6. HPSR field building

Since our establishment, the Division has sought to support HPSR field-building through networking and engagement both within South Africa and more widely, and through the production of relevant resources. These activities have focused on creating spaces for scholarly endeavour and engagement (CHESAI), networking within South Africa (through PHASA, the Public Health Association of South Africa, HPSR Special Interest Group), developing and sharing HPS teaching materials within Africa (CHEPSAA), mentoring Southern-based PhD students conducting HPA work (HPA Fellowship), encouraging conversations and action towards decolonising health systems and supporting Health Systems Global, the global membership body for this field. Further information on these networks is found below.

• CHESAI (Collaboration for Health Systems Analysis and Innovation, click here for more  information)
• CHEPSAA (Consortium for Health Policy and Systems Analysis in Africa, click here for more) information).
• HPA (Health Policy Analysis) Fellowship programme (click here for more information)
• Health Systems Global, click here for more information

We use a variety of approaches to share our work, adapted to read different target audiences. Full publication lists of staff members are also available through their google scholar pages (see ‘Our Team’ profiles).

Here we provide examples of other types of outputs from our work.
 

OpEds

• Cape Town Together: Organizing in a city of islands
• Sparks, flames and blazes: Epidemiological and social firefighting for Covid-19
• 10 Questions about Sizani Universal Healthcare — the DA’s answer to NHI
• Co-production of research with sex workers as a political act
• Global Health is still the “Master’s House”: how brave are we to decolonise and dismantle it?

Advocacy outputs

• Dala Kitchen - more than a Cook Book, a resource for bottom-up organising drawing from the experiences of Cape Town Together and the  Community Action Networks: accessible here
• Child Health advocacy briefs - key issues in relation Child health and COVID: accessible here

Videos and Webinars

• Red Zone Paramedics: a short documentary about the work of the Emergency Medical Services in Cape Town, by Leanne Brady: accessible here
• Cape Town Together: a short documentary on a community-led network initially developed in response to COVID-19, by Leanne Brady: accessible here
• Sex work and COVID: a short documentary calling for the inclusion of sex workers and LGBTI+ people in the state’s emergency response to COVID-19, supported by Lance Louskieter through TEKANO: accessible here
• Decolonizing health systems – a series of conversations
  • Webinar titled Decolonial conversations about our HPSR praxis: accessible here
  • Webinar titled Dismantle. Defund. Decolonise. What do they mean for health?: accessible here
  • Webinar titled Global health, development, and colonialism: accessible here

Selected, recent Journal articles

• Abimbola, S., Asthana, S., Montenegro, C., Guinto, R. R., Jumbam, D. T., Louskieter, L., & Pai, M. (2021). Addressing power asymmetries in global health: Imperatives in the wake of the COVID-19 pandemic. PLoS medicine, 18(4), e1003604. 
   
• Engelbrecht B., Gilson L., Barker P., Vallabhjee K., Kantor G, Budden M., Parbhoo A., Lehman U. (2021). Prioritizing people and rapid learning in times of crisis: A virtual learning initiative to support health workers during the COVID‐19 pandemic. International Journal Health Planning and Management 36(S1):168–173.
   
• Orgill M, Marchal B, Shung-King M, Sikuza L, Gilson L. (2021). Bottom-up innovation for health management capacity development: a qualitative case study in a South African health district. BMC Public Health 21, 587.
   
• Sutherns, T. and Olivier, J. (2021, advanced access). Mapping the Multiple Health System Responsiveness Mechanisms in One Local Health System: A Scoping Review of the Western Cape Provincial Health System of South Africa. International Journal of Health Policy and Management.
   
• Schneider H., Olivier J, Orgill M., Brady L., Whyle E., Zulu J., Sebastian M.S., George A. (2021, advanced access). The Chaminuka Collective. The multiple lenses on the community health system: Implications for policy, practice and research. International Journal of Health Policy and Management.
   
• Whyle E.B. & Olivier J. (2021). Towards an Explanation of the Social Value of Health Systems: An Interpretive Synthesis. International Journal of Health Policy and Management 10(7), 414–42.

Core Academic Staff 

Honorary Professors

Adjunct Associate Professor

Honorary Senior Lecturer

Honorary Research Associate

PhD Candidates

Administrative Staff

Name	Description	Email	Telephone No
Vacant Post	Administrative Assistant