Whole System Change in South Africa: Understanding the experience of health system transformation in the Western Cape province (WholeSyst-SA)

种族隔离结束20年后，评价南非卫生系统改革经验的时机已经成熟。许下了很多承诺，也进行了许多改革-但取得了多少成就，特别是对最脆弱和以前处于不利地位的群体而言？哪些因素促成或制约了整个公共卫生系统的变革，而公共卫生系统被国家公认为改善弱势群体健康和福祉的前沿力量？过去的经验对继续努力改善医疗保健和健康有什么启示？需要长期跟踪哪些问题，以生成支持未来政策和管理决策所需的证据？这项提议的赠款旨在解决这些问题。它是由西开普省的公共卫生系统决策者/管理者和研究人员联合提交的。由于南非是一个准联邦国家，WC省政府有宪法责任确保其人口的有效卫生系统。在过去20年里，它在持续实施这种变革方面也享有相对有效的声誉。将一个省的具体经验与更广泛的国家经验进行比较，将有助于深入调查南非卫生系统的改革。该项目不仅要考虑已经实施了哪些变革，取得了哪些成就和面临哪些挑战，还要考虑哪些政治、领导、组织和其他因素支持或限制了变革的实施。通过这项分析，它将寻求确定改变该省卫生系统发展的途径。项目团队的经验和专业知识将支持这一深入调查，更好地了解该省取得了什么成就，以及如何在全国范围内取得成就，将为全国乃至国际提供相关的见解。更具体地说，它还将通过支持省级卫生系统的监测和评价活动，并确定相关的更大规模的研究需求，为支持未来的政策和管理决策提供所需的证据基础。

Twenty years after the ending of apartheid the time is ripe to evaluate South African experience of health system transformation. Much was promised and many changes have been introduced - but how much has been achieved, especially for the most vulnerable and previously disadvantaged groups? What factors have enabled or constrained change across the public health system, nationally recognised as the leading edge of efforts to improve the health and well-being of vulnerable groups? What lessons does past experience hold for continuing efforts to improve health care and health? What issues need to be tracked over time to generate the evidence needed to support future policy and managerial decision-making?This proposed grant intends to address these questions. It is jointly submitted by a team of public health system policy-makers/managers and researchers based in the Western Cape (WC) province. As South Africa is a quasi-federal state, the WC provincial government has the constitutional responsibility for ensuring an effective health system for its population. It also has a reputation for having been relatively effective in sustaining implementation of such change over the last 20 years. Examining the particular experience of one province, in comparison with wider national experience, will allow in-depth investigation of South African health system transformation. The project will consider not only what changes have been implemented, with what achievements and challenges, but also what set of political, leadership, organisational and other factors have supported or limited the implementation of change. From this analysis it will seek to identify the pathways to change underpinning health system development in the province. The project team's combination of experience and expertise will support this in-depth investigation.Better understanding of what the province has achieved and how, set against the national context, will offer insights of relevance across the country, as well as internationally. It will also, more specifically, contribute to generating the evidence base needed to support future policy and management decision-making, by supporting provincial health system monitoring and evaluation activities and identifying related, larger scale research needs.