Leadership and governance of community health worker programmes at scale: a cross case analysis of provincial implementation in South Africa.
Leadership and governance of community health worker programmes at scale: a cross case analysis of provincial implementation in South Africa.
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DOI：
10.1186/s12939-017-0565-3
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发表时间：
2017-09-15
影响因子：
4.8
通讯作者：
Nxumalo N
中科院分区：
文献类型：
--
作者：
Schneider H;Nxumalo N
国家社区卫生工作者方案作为初级卫生保健系统的一个组成部分正在重新受到青睐，这往往是在先前存在的社区倡议的基础上进行的。在整合和支持这些方案方面存在重大挑战，需要在卫生系统各级进行协调和管理。本文探讨了领导和治理任务的大型CHW方案在次国家一级，通过国家改革的情况下，南非的社区为基础的部门，被称为病房为基础的外展队（WBOT）的战略。根据在省一级（西开普省、西北省和豪登省）采用和实施WBOT战略的三个案例研究，对领导和治理作用进行了跨案例分析。主要案例研究绘制了系统组成部分，并评估了实施过程和背景。这些研究涉及研究人员团队和200多名从高级到一线的利益相关者的访谈，文件审查和常规数据分析。第二次跨案例分析特别侧重于省级和县级决策者和管理人员在执行新的国家任务时面临的问题和挑战以及采取的战略。在此基础上，确定了国家以下各级的关键领导和治理作用。在国家授权与省和地区的历史和社区服务战略之间进行谈判，确定社区卫生工作者、地方卫生服务机构、社区和非政府组织之间新的组织和问责关系，修订和开发新的统一和综合规划、人力资源、融资和信息系统，通过建立新的集体愿景，动员政治，包括预算，支持和设计执行战略。四个关键角色的确定和讨论：这种分析，从现实生活中的系统，增加了参与开发CHW方案的规模，特别是谈判和多层次性质的领导和治理，在这样的方案，跨越分析，管理，技术和政治角色的过程的理解。
National community health worker (CHW) programmes are returning to favour as an integral part of primary health care systems, often on the back of pre-existing community based initiatives. There are significant challenges to the integration and support of such programmes, and they require coordination and stewardship at all levels of the health system. This paper explores the leadership and governance tasks of large-scale CHW programmes at sub-national level, through the case of national reforms to South Africa’s community based sector, referred to as the Ward Based Outreach Team (WBOT) strategy. A cross case analysis of leadership and governance roles, drawing on three case studies of adoption and implementation of the WBOTs strategy at provincial level (Western Cape, North West and Gauteng) was conducted. The primary case studies mapped system components and assessed implementation processes and contexts. They involved teams of researchers and over 200 interviews with stakeholders from senior to frontline, document reviews and analyses of routine data. The secondary, cross case analysis specifically focused on the issues and challenges facing, and strategies adopted by provincial and district policy makers and managers, as they engaged with the new national mandate. From this key sub-national leadership and governance roles were formulated. Negotiating a fit between national mandates and provincial and district histories and strategies of community based services Defining new organisational and accountability relationships between CHWs, local health services, communities and NGOs Revising and developing new aligned and integrated planning, human resource, financing and information systems Leading change by building new collective visions, mobilising political, including budgetary, support and designing implementation strategies. Four key roles are identified and discussed: This analysis, from real-life systems, adds to understanding of the processes involved in developing CHW programmes at scale, and specifically the negotiated and multilevel nature of leadership and governance in such programmes, spanning analytic, managerial, technical and political roles.
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影响因子：
2.8
作者：
McLaren ZM;Ardington C;Leibbrandt M
通讯作者：
Leibbrandt M
影响因子：
4.1
作者：
Nambiar, Devaki;Sheikh, Kabir
通讯作者：
Sheikh, Kabir
影响因子：
3.3
作者：
Bennett, Sara;George, Asha;Cliff, Julie
通讯作者：
Cliff, Julie
影响因子：
4.7
作者：
Hill, Michael;Hupe, Peter
通讯作者：
Hupe, Peter
影响因子：
2.8
作者：
Schneider, Helen;Schaay, Nikki;Qukula, Tobeka
通讯作者：
Qukula, Tobeka