Strengthening the health system for a people-centred community orientation in South Africa. A formative study.
Medical Research Council
University of KwaZulu-Natal
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.
8.1 Organisation and delivery of services / Research Grant