Monitoring and evaluation of eye health service delivery: a public-private case study in the uMgungundlovu District, KwaZulu-Natal.

Abstract

Public health service delivery in South Africa is plagued by a myriad of challenges which has intensified in the last decade. Exploring barriers to service delivery is fundamental for problem-solving, and evident that solutions to healthcare challenges cannot be addressed by government alone. Collaborative efforts between public, private and civil society sectors are imperative if national development goals and international pacts are to be honoured. The empirical study looked into public-private partnerships (PPPs) to improve delivery of cataract surgery in the uMgungundlovu District, KwaZulu-Natal. Cataracts are one of the leading causes of avoidable blindness globally. Inequitable distribution of resources, fiscal limitations, neglect of infrastructure, amongst others, led to considerable delays for surgery, rendering people avoidably blind. The study explored health-related administrative and management barriers to effective public eye health service delivery establishing if a publicprivate health forum implemented in the district contributed to improved service delivery. Theorised within the Logic Model and 5C Protocol, it allowed for reflection and connection between policy and practice. Qualitatively, the study was conducted through interviews of Public-Private Eye Health Forum stakeholders including healthcare workers and managers. Results were analysed using content and thematic analysis. Emergent themes included lack of reliable patient information systems as a hindrance to eye health service delivery, and the benefit of PPPs to address cataract surgery burden in the public sector. Health forums as a means to improving access to health service delivery must leverage strengths and resources of each sector. It is recommended that a partnership model for such forums be designed with monitoring and evaluation indicators built into formative planning processes, observed and managed throughout implementation. Whilst guidelines for PPPs exists in theory, unique construct of forums in practice ought to consider administratively sound frameworks for successful implementation. Uniformity in processes and reporting systems are necessary for successful collaborative engagements.