Implementation of health management systems in Department of Health primary health care facilities in uMkhanyakude District, KwaZulu-Natal.
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Date
2022
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Abstract
South Africa, as in many other countries, has had challenges attaining health outcomes, and has
attributed this to weak health systems. Management strengthening has been prioritised as a critical entry
point and core element towards strengthening the health system. Poor management of primary health
care facilities has been identified as a major challenge to improving quality of health services. The
study aimed to examine the role played by Operational Managers (OMs) on the implementation of
health management systems at primary health care facilities in the uMkhanyakude Health District in the
Province of KwaZulu-Natal. The World Health Organisation’s conceptual frameworks for health
systems performance systems, General Systems theory and Contingency theory were used as lenses to
support the study. This study was exploratory in nature, and conducted through qualitative research
methodology wherein OMs and primary health care Supervisors/Managers as the line managers of OMs
in 56 primary health care facilities in the KZN DoH, uMkhanyakude Health District were purposively
selected and interviewed through semi-structured in-depth interviews. The findings included that most
management decisions, including planning, budget planning, workforce planning, supply chain and
financial management, are centralised and controlled at the sub-district level, hence OMs play an
insignificant role. OMs are not involved in planning, budgeting, and management of expenditure,
management of supply chain or maintenance. The inadequate support and mentorship, lack of
management training, ineffective centralised management systems, shortage of staff and too many
programmes make it impossible for OMs to successfully implement their management functions,
leading to a weak health system. It is recommended that the inputs and suggestions of OMs must be
sought or they must be partially involved in critical decision-making as they are responsible for
management of operations at this level. A systemic thinking approach when formulating management
strengthening interventions will ensure that the focus is on resolving challenges across all management
components and will strengthen the entire health system.
Description
Doctoral Degree. University of KwaZulu-Natal, Durban.