Piercing the veil on the functioning and effectiveness of district health system governance structures: perspectives from a South African province.
Accountability
District health system
Gauteng
Governance
Universal health coverage
Journal
Health research policy and systems
ISSN: 1478-4505
Titre abrégé: Health Res Policy Syst
Pays: England
ID NLM: 101170481
Informations de publication
Date de publication:
31 Aug 2023
31 Aug 2023
Historique:
received:
19
06
2023
accepted:
11
08
2023
medline:
4
9
2023
pubmed:
1
9
2023
entrez:
31
8
2023
Statut:
epublish
Résumé
Leadership and governance are critical for achieving universal health coverage (UHC). In South Africa, aspirations for UHC are expressed through the proposed National Health Insurance (NHI) system, which underscores the importance of primary health care, delivered through the district health system (DHS). Consequently, the aim of this study was to determine the existence of legislated District Health Councils (DHCs) in Gauteng Province (GP), and the perceptions of council members on the functioning and effectiveness of these structures. This was a mixed-methods, cross-sectional study in GP's five districts. The population of interest was members of existing governance structures who completed an electronic-self-administered questionnaire (SAQ). Using a seven-point Likert scale, the SAQ focuses on members' perceptions on the functioning and effectiveness of the governance structures. In-depth interviews with the chairpersons of the DHCs and its technical committees complemented the survey. STATA® 13 and thematic analysis were used to analyze the survey data and interviews respectively. Only three districts had constituted DHCs. The survey response rate was 73%. The mean score for perceived functioning of the structures was 4.5 (SD = 0.7) and 4.8. (SD = 0.7) for perceived effectiveness. The interviews found that a collaborative district health development approach facilitated governance. In contrast, fraught inter-governmental relations fueled by the complexity of governing across two spheres of government, political differences, and contestations over limited resources constrained DHS governance. Both the survey and interviews identified gaps in accountability to communities. In light of South Africa's move toward NHI, strengthening DHS governance is imperative. The governance gaps identified need to be addressed to ensure support for the implementation of UHC reforms.
Sections du résumé
BACKGROUND
BACKGROUND
Leadership and governance are critical for achieving universal health coverage (UHC). In South Africa, aspirations for UHC are expressed through the proposed National Health Insurance (NHI) system, which underscores the importance of primary health care, delivered through the district health system (DHS). Consequently, the aim of this study was to determine the existence of legislated District Health Councils (DHCs) in Gauteng Province (GP), and the perceptions of council members on the functioning and effectiveness of these structures.
METHODS
METHODS
This was a mixed-methods, cross-sectional study in GP's five districts. The population of interest was members of existing governance structures who completed an electronic-self-administered questionnaire (SAQ). Using a seven-point Likert scale, the SAQ focuses on members' perceptions on the functioning and effectiveness of the governance structures. In-depth interviews with the chairpersons of the DHCs and its technical committees complemented the survey. STATA® 13 and thematic analysis were used to analyze the survey data and interviews respectively.
RESULTS
RESULTS
Only three districts had constituted DHCs. The survey response rate was 73%. The mean score for perceived functioning of the structures was 4.5 (SD = 0.7) and 4.8. (SD = 0.7) for perceived effectiveness. The interviews found that a collaborative district health development approach facilitated governance. In contrast, fraught inter-governmental relations fueled by the complexity of governing across two spheres of government, political differences, and contestations over limited resources constrained DHS governance. Both the survey and interviews identified gaps in accountability to communities.
CONCLUSION
CONCLUSIONS
In light of South Africa's move toward NHI, strengthening DHS governance is imperative. The governance gaps identified need to be addressed to ensure support for the implementation of UHC reforms.
Identifiants
pubmed: 37653433
doi: 10.1186/s12961-023-01044-z
pii: 10.1186/s12961-023-01044-z
pmc: PMC10469879
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
89Subventions
Organisme : Atlantic Philanthropies
ID : grant no. 21408
Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
Références
J Biomed Inform. 2009 Apr;42(2):377-81
pubmed: 18929686
Health Policy Plan. 2014 Sep;29(6):685-93
pubmed: 23411121
Health Expect. 2014 Aug;17(4):488-99
pubmed: 22512734
Lancet Glob Health. 2018 Feb;6(2):e152-e168
pubmed: 29248365
Lancet. 2023 Jun 24;401(10394):2101
pubmed: 37356437
Health Res Policy Syst. 2020 Jun 3;18(1):55
pubmed: 32493349
BMC Public Health. 2015 Sep 21;15:932
pubmed: 26390867
Global Health. 2016 Oct 26;12(1):64
pubmed: 27782831
BMC Health Serv Res. 2016 Oct 7;16(1):558
pubmed: 27717353
Int Health. 2014 Sep;6(3):249-57
pubmed: 24711600
Health Policy Plan. 2017 Jun 1;32(5):710-722
pubmed: 28334991
BMJ Qual Saf. 2014 Jun;23(6):474-82
pubmed: 24327735
BMC Int Health Hum Rights. 2012 Aug 25;12:15
pubmed: 22920557
BMC Health Serv Res. 2013 Aug 16;13:320
pubmed: 23953492
BMJ Glob Health. 2018 Sep 28;3(5):e000939
pubmed: 30294460
Int J Equity Health. 2020 Mar 2;19(1):30
pubmed: 32122333
Health Policy. 2009 Apr;90(1):13-25
pubmed: 18838188
BMC Health Serv Res. 2020 Dec 14;20(1):1142
pubmed: 33317520
BMJ Glob Health. 2017 Jun 2;2(2):e000224
pubmed: 29081995
Oncol Nurs Forum. 2014 Sep;41(5):545-7
pubmed: 25158659
BMC Int Health Hum Rights. 2013 Aug 09;13:34
pubmed: 23927531
BMC Health Serv Res. 2021 Oct 19;21(1):1120
pubmed: 34666755
Soc Sci Med. 2015 Jun;135:1-14
pubmed: 25931377