Strengthening the health system for a people-centred community orientation in South Africa. A formative study.

Lead Research Organisation: University of KwaZulu-Natal
Department Name: Faculty of Health Sciences

Abstract

Health systems in sub-Saharan Africa are typically fragile, reactive and organized around responding to specific diseases. This makes them ill-equipped to deal with multiple co-existing conditions such as tuberculosis, HIV and non-communicable diseases as well as emerging health shocks, such as COVID-19. The need to build resilient and responsive quality health systems is paramount. To this end, people-centred oriented systems which focus on health promotion and prevention interventions and empowering people to take responsibility for their health and that of their communities have been identified as the way forward for sub-Saharan Africa. This need is amplified in the context of COVID-19 which requires people to change their behavior to prevent the spread of the virus. This requires strengthening of the community sub-system (historically a neglected component of the health system) including households, civic groups, community structures and other sectors to play an active rather than passive role in the health care system.
While the SA Dept of Health has engaged in policy reforms to strengthen the system to have a more people-centred community orientation, there are gaps in knowledge about how best to practically achieve these reforms. To narrow this gap, the applicants have partnered with the KwaZulu-Natal (KZN) provincial Department of Health (DoH), to investigate how best to implement these reforms. To this end, we will conduct a formative investigation of the barriers, needs and opportunities for strengthening of the pillars of the health system to be enabling of a people-centred community orientation. This information will be used to inform the co-development (with the KZN DoH and other sectors) of conceptual models of how the pillars of the health system could be strengthened to be more enabling of a people-centred community orientation. Testing and refining of these conceptual models will form the basis of a full stage proposal.

Technical Summary

Health systems in sub-Saharan Africa are typically fragile, reactive and vertically organised - being ill-equipped to deal with multiple co-existing health problems, such as malaria, tuberculosis, HIV and non-communicable diseases; as well as emerging shocks such as COVID-19. The Lancet Commission on the future of health in sub-Saharan Africa identified health systems reforms towards people-centred systems as necessary for achieving longer and healthier lives in this region. People-centredness focuses on prevention and health promotion - empowering people to be more in control of their health and that of their communities. Strengthening of the community sub-system - a historically neglected component of the health system, comprising households, civic groups, community structures and other sectors - is central to strengthening a people-centred health system. While there is political will on the part of the South African Department of Health to make a shift towards a people-centred community-oriented health system, visible in policies promoting re-engineering of primary health care (PHC) in particular; there is a knowledge gap on how to implement these reforms operationally.
To provide academic direction to closing this knowledge gap, the applicants have partnered with the KwaZulu-Natal provincial Department of Health and NGOs to provide strategic academic direction to achieve these reforms operationally. Through this foundation grant, we will conduct a formative investigation of the barriers, needs and opportunities for strengthening of the pillars of the health system as conceptualized by the Lancet Commission of Quality Health systems. Guided by Realist Evaluation (RE), this formative work will inform the co-development of Initial Programme Theories (IPT) which will provide logical conceptual models for strengthening of these key pillars, including multisectoral approaches.Testing and refining these models will form the scope of work for a full-stage proposal.

Publications

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Schneider H (2023) Special series on the District Health System in South African Medical Journal

 
Description Adoption and integration of screening tools developed during research, into policy and practice
Geographic Reach Africa 
Policy Influence Type Participation in a guidance/advisory committee
Impact Healthcare workers in KwaZulu-Natal province have received training in the BMH tool regionally. The tool has been adopted into practice to provide a standardized screening tool for common mental health disorders at primary health care. Community Health Workers (CHWs) and their supervisors have received training in the CMED in one district and the training is in the process of being scaled up by the KZNDOH to other districts. This tool equips CHWs to screen for common mental disorders at community level and refer patients to primary care for assessment.
 
Description Primary Health Care Transformation Committee 
Organisation Government of South Africa
Department Department of Health
Country South Africa 
Sector Public 
PI Contribution A Primary Health Care Transformation Committee (PHCTC) was established as a collaborative forum between the KwaZulu-Natal Department of Health and the University of KwaZulu-Natal. A Theory Of Change, co-developed within the PHCTC was used to strategically guide project activities and outcomes.
Collaborator Contribution Strategic guidance on research conducted, research planned, collaboration on potential funding and research required/focal areas by the Department of Health
Impact None
Start Year 2022
 
Description South African Learning Alliance for District Health Systems 
Organisation Nelson Mandela University
Country South Africa 
Sector Academic/University 
PI Contribution Professor Petersen is one of the founding members of the Alliance. The research team on this award participate in workshops, meetings deliberating how to strengthen the district health system in South Africa inclusive of a people-centred approach and are contributing to a special issue in the South African Medical Journal.
Collaborator Contribution In kind contributions are made to partners to travel to attend meetings, workshops and deliberations towards strengthening the district health system in South Africa inclusive of a people-centred approach and partners are contributing to a special issue in the South African Medical Journal.
Impact An introductory article in the South African Medical Journal "Special series on the District Health System". Professor Petersen and Mr Jabulani Mndebele (Chief Director of District Health services in the KwaZulu-Natal Department of Health) and Leader of the Primary Health Care Transformation Committe are authors.
Start Year 2023
 
Description South African Learning Alliance for District Health Systems 
Organisation North-West University
Country South Africa 
Sector Academic/University 
PI Contribution Professor Petersen is one of the founding members of the Alliance. The research team on this award participate in workshops, meetings deliberating how to strengthen the district health system in South Africa inclusive of a people-centred approach and are contributing to a special issue in the South African Medical Journal.
Collaborator Contribution In kind contributions are made to partners to travel to attend meetings, workshops and deliberations towards strengthening the district health system in South Africa inclusive of a people-centred approach and partners are contributing to a special issue in the South African Medical Journal.
Impact An introductory article in the South African Medical Journal "Special series on the District Health System". Professor Petersen and Mr Jabulani Mndebele (Chief Director of District Health services in the KwaZulu-Natal Department of Health) and Leader of the Primary Health Care Transformation Committe are authors.
Start Year 2023
 
Description South African Learning Alliance for District Health Systems 
Organisation University of Cape Town
Country South Africa 
Sector Academic/University 
PI Contribution Professor Petersen is one of the founding members of the Alliance. The research team on this award participate in workshops, meetings deliberating how to strengthen the district health system in South Africa inclusive of a people-centred approach and are contributing to a special issue in the South African Medical Journal.
Collaborator Contribution In kind contributions are made to partners to travel to attend meetings, workshops and deliberations towards strengthening the district health system in South Africa inclusive of a people-centred approach and partners are contributing to a special issue in the South African Medical Journal.
Impact An introductory article in the South African Medical Journal "Special series on the District Health System". Professor Petersen and Mr Jabulani Mndebele (Chief Director of District Health services in the KwaZulu-Natal Department of Health) and Leader of the Primary Health Care Transformation Committe are authors.
Start Year 2023
 
Description South African Learning Alliance for District Health Systems 
Organisation University of Free State, Bloemfontein
Country South Africa 
Sector Academic/University 
PI Contribution Professor Petersen is one of the founding members of the Alliance. The research team on this award participate in workshops, meetings deliberating how to strengthen the district health system in South Africa inclusive of a people-centred approach and are contributing to a special issue in the South African Medical Journal.
Collaborator Contribution In kind contributions are made to partners to travel to attend meetings, workshops and deliberations towards strengthening the district health system in South Africa inclusive of a people-centred approach and partners are contributing to a special issue in the South African Medical Journal.
Impact An introductory article in the South African Medical Journal "Special series on the District Health System". Professor Petersen and Mr Jabulani Mndebele (Chief Director of District Health services in the KwaZulu-Natal Department of Health) and Leader of the Primary Health Care Transformation Committe are authors.
Start Year 2023
 
Description South African Learning Alliance for District Health Systems 
Organisation University of Stellenbosch
Country South Africa 
Sector Academic/University 
PI Contribution Professor Petersen is one of the founding members of the Alliance. The research team on this award participate in workshops, meetings deliberating how to strengthen the district health system in South Africa inclusive of a people-centred approach and are contributing to a special issue in the South African Medical Journal.
Collaborator Contribution In kind contributions are made to partners to travel to attend meetings, workshops and deliberations towards strengthening the district health system in South Africa inclusive of a people-centred approach and partners are contributing to a special issue in the South African Medical Journal.
Impact An introductory article in the South African Medical Journal "Special series on the District Health System". Professor Petersen and Mr Jabulani Mndebele (Chief Director of District Health services in the KwaZulu-Natal Department of Health) and Leader of the Primary Health Care Transformation Committe are authors.
Start Year 2023
 
Description South African Learning Alliance for District Health Systems 
Organisation University of the Western Cape
Country South Africa 
Sector Academic/University 
PI Contribution Professor Petersen is one of the founding members of the Alliance. The research team on this award participate in workshops, meetings deliberating how to strengthen the district health system in South Africa inclusive of a people-centred approach and are contributing to a special issue in the South African Medical Journal.
Collaborator Contribution In kind contributions are made to partners to travel to attend meetings, workshops and deliberations towards strengthening the district health system in South Africa inclusive of a people-centred approach and partners are contributing to a special issue in the South African Medical Journal.
Impact An introductory article in the South African Medical Journal "Special series on the District Health System". Professor Petersen and Mr Jabulani Mndebele (Chief Director of District Health services in the KwaZulu-Natal Department of Health) and Leader of the Primary Health Care Transformation Committe are authors.
Start Year 2023
 
Description South African Learning Alliance for District Health Systems 
Organisation University of the Witwatersrand
Country South Africa 
Sector Academic/University 
PI Contribution Professor Petersen is one of the founding members of the Alliance. The research team on this award participate in workshops, meetings deliberating how to strengthen the district health system in South Africa inclusive of a people-centred approach and are contributing to a special issue in the South African Medical Journal.
Collaborator Contribution In kind contributions are made to partners to travel to attend meetings, workshops and deliberations towards strengthening the district health system in South Africa inclusive of a people-centred approach and partners are contributing to a special issue in the South African Medical Journal.
Impact An introductory article in the South African Medical Journal "Special series on the District Health System". Professor Petersen and Mr Jabulani Mndebele (Chief Director of District Health services in the KwaZulu-Natal Department of Health) and Leader of the Primary Health Care Transformation Committe are authors.
Start Year 2023
 
Description Tools Integration Committee 
Organisation Government of South Africa
Department Department of Health
Country South Africa 
Sector Public 
PI Contribution Based on recommendations of the Primary Health Care Transformation Committe which collaborates with the University of KwaZulu-Natal, and is led by the Centre for Rural Health within which this project is based, a committee was nominated to facilitate the integration of research developed tools that have been adopted by the Department of Health (DOH), with other screening tools currently used by the DOH. This committee has met most recently in March 2024 to discuss strategies for integration of a community-based screening tool and a facility-based screening tool for common mental health disorders with tools currently in use.
Collaborator Contribution Workshops to discuss strategies for integration and adoption of screening tools for common mental disorders
Impact None
Start Year 2023