Leadership and the functioning of maternal health services in two rural district hospitals in South Africa

Maternal mortality remains high in Eastern Cape Province, South Africa, despite over 90% of pregnant women utilizing maternal health services. A recent survey showed wide variation in performance among districts in the province. Heterogeneity was also found at the district level, where maternal health outcomes varied considerably among district hospitals. In ongoing research, leadership emerged as one of the key health systems factors affecting the performance of maternal health services at facility level. This article reports on a subsequent case study undertaken to examine leadership practices and the functioning of maternal health services in two resource-limited hospitals with disparate maternal health outcomes. An exploratory mixed-methods case study was undertaken with the two rural district hospitals as the units of analysis. The hospitals were purposively selected based on their maternal health outcomes: one reported good maternal health outcomes (pseudonym: Chisomo) and the other had poor outcomes (pseudonym: Tinyade). Comparative data were collected through a facility survey, non-participant observation of management and perinatal meetings, record reviews and interviews with hospital leadership, staff and patients to elicit information about leadership practices including supervision, communication and teamwork. Descriptive and thematic data analysis was undertaken. The two hospitals had similar infrastructure and equipment. Hospital managers at Chisomo used their innovation and entrepreneurial skills to improve quality of care, and leadership style was described as supportive, friendly, approachable but ‘firm’. They also undertook frequent and supportive supervisory meetings. Each department at Chisomo developed its own action plan and used data to monitor their actions. Good performers were acknowledged in group meetings. Staff in this facility were motivated and patients were happy about the quality of services. The situation was different at Tinyade hospital. Participants described the leadership style of their senior managers as authoritarian. Managers were rarely available in the office and did not hold regular meetings, leading to poor communication across teams and poor coordination to address resource constraints. This demotivated the staff. The differences in leadership style, structures, processes and work culture affected teamwork, managerial supervision and support. The study demonstrates how leadership styles and practices influence maternal health care services in resource limited hospitals. Supportive leadership manifested itself in the form of focused efforts to build teamwork, enhance entrepreneurship and in management systems that are geared to improving maternal care

Post-doctoral research fellowship as a health policy and systems research capacity development intervention: a case of the CHESAI initiative

BACKGROUND: Building capacity in health policy and systems research (HPSR), especially in low- and middle-income countries, remains a challenge. Various approaches have been suggested and implemented by scholars and institutions using various forms of capacity building to address challenges regarding HPSR development. The Collaboration for Health Systems Analysis and Innovation (CHESAI) – a collaborative effort between the Universities of Cape Town and the Western Cape Schools of Public Health – has employed a non-research based post-doctoral research fellowship (PDRF) as a way of building African capacity in the field of HPSR by recruiting four post-docs. In this paper, we (the four post-docs) explore whether a PDRF is a useful approach for capacity building for the field of HPSR using our CHESAI PDRF experiences. METHODS: We used personal reflections of our written narratives providing detailed information regarding our engagement with CHESAI. The narratives were based on a question guide around our experiences through various activities and their impacts on our professional development. The data analysis process was highly iterative in nature, involving repeated meetings among the four post-docs to reflect, discuss and create themes that evolved from the discussions. RESULTS: The CHESAI PDRF provided multiple spaces for our engagement and capacity development in the field of HPSR. These spaces provided us with a wide range of learning experiences, including teaching and research, policy networking, skills for academic writing, engaging practitioners, co-production and community dialogue. Our reflections suggest that institutions providing PDRF such as this are valuable if they provide environments endowed with adequate resources, good leadership and spaces for innovation. Further, the PDRFs need to be grounded in a community of HPSR practice, and provide opportunities for the post-docs to gain an in-depth understanding of the broader theoretical and methodological underpinnings of the field. CONCLUSION: The study concludes that PDRF is a useful approach to capacity building in HPSR, but it needs be embedded in a community of practice for fellows to benefit. More academic institutions in Africa need to adopt innovative and flexible support for emerging leaders, researchers and practitioners to strengthen our health systemsIS

Social Assistance in Developing Countries Database Version 5.0

The Social Assistance in Developing Countries Database is a user-friendly tool that provides summary information on social assistance interventions in developing countries. It provides a summary of the evidence available on the effectiveness of social assistance interventions in developing countries. It focuses on programmes seeking to combine the reduction and mitigation of poverty, with strengthening and facilitating household investments capable of preventing poverty and securing development in the longer term. The inclusion of programmes is on the basis of the availability of information on design features, evaluation, size, scope, or significance. Version 5 of the database updates information on existing programmes and incorporates information on pilot social assistance programmes in Latin America, Asia and Africa. It also adopts a new typology that distinguishes between social assistance programmes providing pure income transfers; programmes that provide transfers plus interventions aimed at human, financial, or physical asset accumulation; and integrated poverty reduction programmes. This new typology has, in our view, several advantages. It is a more flexible, and more accurate, template with which to identify key programme features. It provides a good entry point into the conceptual underpinnings of social assistance programmes

Analysis of the effectiveness of Non Governmental Organizations (NGOs) in HIV and AIDS Service Delivery

In den vergangenen drei Jahrzehnten gab es eine rasche Zunahme der Zahl der Nicht-Regierungs-Organisationen (NGOs) in allen Bereichen der Entwicklung. Diese Studie untersucht die Wirksamkeit von NGOs bei der Bereitstellung von antiretroviralen Therapie Dienstleistungen in Malawi. Er vergleicht die Qualität und Kosteneffizienz von NGOs, Regierungen und den for-Profit-Sektor. Daten über die ART-Programm Ergebnisse wurden von der HIV und AIDS-Einheit gesammelt, in dem Gesundheitsministerium. Mortality Ergebnisse zeigen, dass der Staatssektor die schlechteste Sterblichkeit von 17,7 Todesfälle pro 100 Personenjahre hat, der NGOs mit 15.2, gefolgt vom for-profit mit 12.2. Der öffentliche Sektor ist der Kostengünstige mit einem Kosten-Nutzen-Verhältnis von 199.74 US$pro Person und Jahr gelebt, gefolgt von NGOs (267.00 US$) und dem for-profit (370.98 US$). Die Studie kommt zu dem Schluss, dass die NGO-Sektor kritische Spieler in HIV-und AIDS-Service Delivery in Malawi ist.In the past three decades, there has been a rapid increase in the number of Non-Governmental Organisations (NGOs) operating in all areas of development. This study analyses the effectiveness of NGOs in providing antiretroviral therapy services in Malawi. It compares the quality and cost-effectiveness of NGOs, government and the for-profit sectors. Data on the ART programme outcomes was collected from the HIV and AIDS unit, in the Ministry of Health. Mortality outcomes show that the government sector has the worst mortality rate of 17.7 deaths per 100 person years followed by the NGOs with15.2 and the for-profit with12.2. The government sector is the most cost-effective with a cost-effectiveness ratio of 199.74US$ per person year lived, followed by NGOs (267.00US$) and the for-profit (370.98US$). The study concludes that the NGO sector is critical player in HIV and AIDS service delivery in Malawi

The same course, different access: the digital divide between urban and rural distance education students in South Africa

Access to education is a significant determinant in future success, not only for a country but equally for individuals. Higher Education (HE) thus is an integral part of the Sustainable Development Goals and vital in supporting African development. Despite this, there is often a lack of access to HE in many parts of Africa, distance education can subsequently play an important role in increasing access to education by providing materials online. Even though institutions such as the University of South Africa, a provider of Open Distance Learning (ODL), can open access to HE for many marginalised and peripheral communities, we cannot separate access to ODL education from the debate of access to ICTs. Students in urban areas have a significantly different educational experience to students with poor ICT access in urban, peri-urban and rural areas. This paper explores the nature of access to ICT and how this affects students’ ability to access HE

The targeting effectiveness of social transfers

Many methodologies exist for dividing a population into those who are classified as eligible for social transfers and those who are ineligible. Popular targeting mechanisms include means tests, proxy means tests, categorical, geographic, community-based and self-selection. This paper reviews empirical evidence from a range of social protection programmes on the accuracy of these mechanisms, in terms of minimising four targeting errors: inclusion and exclusion, by eligibility and by poverty. This paper also reviews available evidence on the various costs associated with targeting, not only administrative but also private, social, psycho-social, incentive-based and political costs. Comparisons are difficult, but all mechanisms generate targeting errors and costs. Given the inevitability of trade-offs, there is no ‘best’ mechanism for targeting social transfers. The key determinant of relative accuracy and cost-effectiveness in each case is how well the targeting mechanism is designed and implemented