Strengthening health system responsiveness to citizen feedback in South Africa and Kenya
Responsiveness to citizen rights, needs, expectations and values is understood to be an essential quality of health systems. For some time, health system responsiveness has been regarded as both an intrinsic goal and pressing priority for health systems, and the term is commonly used both as an indicator of HS performance in formal assessment frameworks, and colloquially as an HS value and social good. However the citizens in LMICs experience a range of problems with weak health systems that display poor responsiveness. A three-year study will be conducted in South Africa and Kenya – asking the question: “What policies and mechanisms (formal and informal) work for receiving and responding to citizen feedback on health systems in South Africa and Kenya? How can health systems responsiveness be strengthened towards the development of learning, equitable health systems?” The collaborative study will run from 2018 to 2021, and is funded by the MRC (Jointly Funded Initiatives). The main collaborative partners are from UCT (HPS Division), UWC SOPH, KEMRI (Kenya), and local health system partners - the Western Cape Government, Department of Health and County Departments of Health, Kilifi and Mombasa Counties in Kenya.
Health Policy Analysis Fellowship programme
This two year programme is supporting a group of eleven PhD researchers, registered in a range of LMIC universities, focused on analysis of policy process issues. The programme seeks to assist these fellows in sharpening and deepening the focus of their research, building a network among the fellows and also engaging with their supervisors, to support PhD supervision in this field as well. The programme activities include two workshops, some mentoring support around and between the workshops and nine of the fellows are receiving bursary support as well. The overall aim is to develop the pool of those involved in HPA research in LMICs.
Development of a Health Policy Analysis Reader
This Reader will present a set of specially selected conceptual, empirical and methodological papers relevant to understanding and researching policy processes and the politics of policy change. The reader will present the papers in ‘sections’ and each section will include a brief initial written piece providing an overview of the focus of the subject of section, and relevant theory, explaining and justifying the papers selected and providing references to other resource materials.
Engagement between the system and non-state providers in Ghana
Researchers from the HPSD were awarded a three year grant by the Alliance for Health Policy and Systems Research in the World Health Organisation (AHPSR-WHO), to conduct a historical case study of the evolution of the relationship between the non-state (faith-based) providers and the public health system in Ghana. This project will run from 2015-2018, and is conducted in partnership with colleagues from the University of Ghana, Ghana Health Service (GHS), and the Christian Health Association of Ghana (CHAG).
Assessing large-scale health systems intervention practice
A team from UCT are engaged in evaluative research and research support for the Doris Duke Charitable Foundation – focusing on implementation practice in large-scale health systems strengthening interventions. In the first phase (2014-2016), we worked closely with colleagues in Mozambique and Zambia to add a qualitative and process evaluation of the health systems strengthening interventions, focused on health planning and management and primary level quality of care, respectively, they have introduced.
Partnership for Health Leadership and Management (PAHLM)
The HPSD is also involved in a partnership with the School of Public Health at the University of the Western Cape, the Division of Community Health Sciences at the University of Stellenbosch and the Western Cape Department of Health to develop a strategy to strengthen health leadership throughout all levels of the health system of the Western Cape Department of Health. Initial phases of work supported the development of the Western Cape Leadership Development Strategy and Leadership Competency Framework. In the longer-term, the partnership seeks to contribute to the vision and goals of the Provincial Strategy of Health Care 2030, by nurturing and developing a cadre of leaders at all levels of the health system who hold stewardship of Health care 2030.
Collaborative for Health Systems Analysis and Innovation (CHESAI)
CHESAI is a collaborative of health policy and systems researchers based in the Western Cape, South Africa—with a focus on strengthening the health policy and systems research field through conceptual and methodological development, as well as interdisciplinary and multi‐sectoral engagement. CHESAI aims to contribute to expanding and strengthening the health policy and systems knowledge base in Africa: building an intellectual hub for HPSR in Cape Town South Africa; creating spaces for practice‐research engagement; supporting African HSPR capacity development; sharing and disseminating HPSR conceptual and methodological innovations. The main partners are The University of Cape Town and The University of the Western Cape, Schools of Public Health. The first phase of CHESAI (2012-2015) was supported by a grant from the International Development Research Centre, Canada. Please visit www.chesai.org
Resilient and Responsive Health Systems (RESYST)
Resilient and Responsive Health Systems (RESYST) is a Consortium that is undertaking health policy and systems research (with a focus on financing, health workers and governance) in a set of African and Asian settings, including India, Kenya, Nigeria, South Africa, Thailand, Tanzania and Vietnam. Funded by DfID, the consortium began in 2011 and will run until 2018. The Health Policy and Systems Division has a particular focus on the governance agenda within the RESYST programme of work.
District Innovation, Action and Learning for Health System Development (DIALHS)
District and sub-district managers in the South African health system are charged with building, strengthening and managing health systems that implement national policy frameworks. At the same time they need to remain responsive to local needs and contexts, involve multiple actors in decision-making and inspire and motivate staff to be creative in delivering services in resource-constrained settings. This is a complex undertaking, and managers are often hamstrung by the constraints of existing systems while they themselves are not sufficiently well-equipped to navigate between high need, limited resources and inherent system complexity. The District Innovation, Action and Learning for Health System Development (DIALHS) project – initially funded by The Atlantic Philanthropies – engages with these challenges at the implementation level in the sub-district of Mitchell’s Plain in Cape Town, in a partnership between the Schools of Public Health at UCT and UWC, as well as the health departments of the City of Cape Town and the provincial government of the Western Cape.
International Religious Health Assets Programme (IRHAP)
IRHAP is an international collaborative network working on the interface of religion and public health, seeking to gather and develop systematic evidence to align and enhance the work of religious health leaders, public policy decision-makers and other health workers in their collaborative efforts to meet the challenge of disease such as HIV/AIDS, strengthen health and community systems, and to promote sustainable health, especially for those who live in poverty or under marginal conditions. The hub of the IRHAP collaborative is currently based at UCT within the Division of Health Policy and Systems – and a number of related research projects are run from there. www.irhap.uct.ac.za
Ongoing PhD Projects
How And Why Are Different Forms of Evidence used in Policy-Making in the South African Health Sector? A Case Study of the National Core Standards for Health Establishments, the Primary Health Care Re-engineering policy, the Prevention-of-Mother-To-Child Transmission of HIV (PMTCT) Policy for South Africa, and the National Drug Policy.
Strengthening district management as a key lever in health system strengthening: bottom up innovation in two district health systems in South Africa
The Leadership Trinity: Examining the Interplay Between Organisational Context, Leadership Practices and Leadership Effectiveness in the Health Sector - A Case Study of District Hospitals in the Western Cape Province, South Africa.
The social value(s) of health systems: Using health policy analysis of health system reform to explore the potential for socially responsive health systems
Everyday violence and everyday resilience in the South African Health System: A case study of Emergency Medical Services (EMS) in the Western Cape.
The Tyranny of ethnicity: An examination of ethnic influence in health sector resource allocation decision making and implications for horizontal equity in Kenya’s devolved system of governance.
How central level policy actors sustain (or not sustain) public policy reform initiative in Ghana
To explore the contribution of a leadership development program on the implementation of improvement projects at a South African central hospital.
Completed Projects with continued activities
Whole System Change in South Africa (WholeSystSA)
Understanding the experience of health system transformation in the Western Cape province. What public health system performance improvements has the Western Cape province achieved over the last 20 years, and what has enabled or constrained such improvements? The WholeSystSA grant supported formative research to describe and understand the Western Cape experience of whole system evelopment, contributing to the small global pool of such analyses. It confirmed that large-scale health system transformation entails the multiple health system dimensions and levels and occurs over long time periods, as well as the particular importance of political and distributed leadership in effective implementation of health system change. The project also generated ideas that are feeding into discussion of relevant monitoring and evaluation activities of health system development in the Western Cape. WholeSystSA was a joint project between the Western Cape Department of Health, the University of Cape Town, and the University of the Western Cape, funded by the UK’s Health Systems Research Initiative (a funding consortium made up of the Wellcome Trust, ESRC, MRC and UKAID).
The SHICASA (Strengthening School HIV-related Health Services Implementation for Children and Adolescents in South Africa) Project
The HPSD has been subcontracted by the Medical Research Council, in conjunction with other partners, to work on a 5-year CDC funded project on strengthen the implementation of the Integrated School Health Policy in a NHI pilot district in South Africa. While the work is focused in one district, the innovations and lessons that will emanate out of the research is expected to have applicability to school health services across the country as a whole. The project is a 5-year collaboration and is expected to develop practical school-based intervention models, within the parameters of the National Integrated School Health Programme (ISHP). The proposed models of intervention would be evidence-based, using a combination of evidence sources, and the implementation of the models rigorously evaluated, before making recommendations for wider application. The project focuses on key components of the ISHP, with the aim of providing lessons that could strengthen implementation of the many and varied components of the ISHP.
Access, Trust and Information: Catholic health providers in Cameroon, Ghana and Malawi
A research study that ran during 2013 and 2014, looking at improved access to maternal health services in three African countries – in particular looking at the complex policy context that non-profit Catholic health providers negotiate in provision of maternal health and family planning services in three African countries. This project was supported by CORDAID – the Catholic Organisation for Relief and Development.
Collaboration between civil society and the South African health system
A collaborative research study from 2013 to 2014 which was undertaken for the Hospice and Palliative Care Association of South Africa (HPCA) – relating to the Health System Strengthening through Strategic Partnerships (HESP) project. HESP was a pilot project jointly funded by PEPFAR, USAID and the Anglo American Chairman’s Fund – aimed at innovating new mechanisms and approaches for strengthening community systems and local partnerships around health and welfare. This research sought to understand this project, and its lessons for collaborative practice in the South African health system.
Universal coverage in Tanzania and South Africa: monitoring and evaluating progress (UNITAS)
The UNITAS project focuses on monitoring and evaluating policy formulation and implementation processes aimed at achieving universal health coverage in South Africa and Tanzania. The project undertakes monitoring mainly at the district level, with some monitoring and evaluation at the national level. It aims to support implementation processes and will establish an ‘early warning system’ of implementation difficulties. The project runs from 2011 to 2016 and is funded by the European Union. It is a collaborative project with partners from the London School of Hygiene and Tropical Medicine, Ifakara Health Institute (in Tanzania), Institute of Tropical Medicine Antwerp (in Belgium), Centre for Health Policy, University of Witwatersrand and the Africa Centre in South Africa.
Consortium for Health Policy & Systems Analysis in Africa (CHEPSAA)
The Consortium for Health Policy and Systems Analysis in Africa was established as an African-European network that supported capacity development in the field health policy and systems analysis. Activities included curriculum development, staff development and engagement with policy makers in national and regional levels, as well as building a network among the organisational partners. CHEPSAA built on earlier activities funded by the Ford Foundation. It brought together 11 organisational partners from South Africa, Tanzania, Ghana, Kenya, Nigeria, UK, Sweden and Switzerland in the period 2011 to 2014, funded by the European Commission. The official grant-period of CHEPSAA has ended, but the African colleagues have agreed that key activities continue, including the focus on HPS Teaching and Learning, and the networking encouraged through the CHEPSAA website www.hpsa-africa.org
Completed PhDs (download at www.open.uct.ac.za)
Completed MPH Projects (download at www.open.uct.ac.za)