The role of emergent champions in policy implementation for decentralised drug-resistant tuberculosis care in South Africa.
public health
qualitative study
tuberculosis
Journal
BMJ global health
ISSN: 2059-7908
Titre abrégé: BMJ Glob Health
Pays: England
ID NLM: 101685275
Informations de publication
Date de publication:
12 2022
12 2022
Historique:
received:
24
02
2022
accepted:
07
11
2022
entrez:
3
1
2023
pubmed:
4
1
2023
medline:
5
1
2023
Statut:
ppublish
Résumé
Champions are recognised as important to driving organisational change in healthcare quality improvement initiatives in high-income settings. In low-income and middle-income countries with a high disease burden and constrained human resources, their role is highly relevant yet understudied. Within a broader study on policy implementation for decentralised drug-resistant tuberculosis care in South Africa, we characterised the role, strategies and organisational context of emergent policy champions. Interviews with 34 healthcare workers in three South African provinces identified the presence of individuals who had a strong influence on driving policy implementation forward. Additional interviews were conducted with 13 participants who were either identified as champions in phase II or were healthcare workers in facilities in which the champions operated. Thematic analyses using a socio-ecological framework further explored their strategies and the factors enabling or obstructing their agency. All champions occupied senior managerial posts and were accorded legitimacy and authority by their communities. 'Disease-centred' champions had a high level of clinical expertise and placed emphasis on clinical governance and clinical outcomes, while 'patient-centred' champions promoted pathways of care that would optimise patients' recovery while minimising disruption in other spheres of their lives. Both types of champions displayed high levels of resourcefulness and flexibility to adapt strategies to the resource-constrained organisational context. Policymakers can learn from champions' experiences regarding barriers and enablers to implementation to adapt policy. Research is needed to understand what factors can promote the sustainability of champion-led policy implementation, and to explore best management practices to support their initiatives.
Identifiants
pubmed: 36593649
pii: bmjgh-2022-008907
doi: 10.1136/bmjgh-2022-008907
pmc: PMC9743276
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Wellcome Trust
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/N015924/1
Pays : United Kingdom
Informations de copyright
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
S Afr Med J. 2014 Mar;104(3 Suppl 1):244-8
pubmed: 24893501
Health Policy Plan. 2021 Apr 21;36(3):249-259
pubmed: 33582787
Qual Saf Health Care. 2009 Dec;18(6):434-40
pubmed: 19955453
J Am Board Fam Med. 2012 Sep-Oct;25(5):676-85
pubmed: 22956703
J Telemed Telecare. 2012 Dec;18(8):490-2
pubmed: 23209264
S Afr Med J. 2016 Mar 07;106(4):32-5
pubmed: 27032842
SAGE Open Med. 2018 Aug 01;6:2050312118792426
pubmed: 30083320
Implement Sci. 2015 Feb 12;10:21
pubmed: 25889199