Strengthening the health system for a people-centred community orientation in South Africa. A formative study.

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Health systems in sub-Saharan Africa are typically fragile, reactive and organized around responding to specific diseases. This makes them ill-equipped to deal with multiple co-existing conditions such as tuberculosis, HIV and non-communicable diseases as well as emerging health shocks, such as COVID-19. The need to build resilient and responsive quality health systems is paramount. To this end, people-centred oriented systems which focus on health promotion and prevention interventions and empowering people to take responsibility for their health and that of their communities have been identified as the way forward for sub-Saharan Africa. This need is amplified in the context of COVID-19 which requires people to change their behavior to prevent the spread of the virus. This requires strengthening of the community sub-system (historically a neglected component of the health system) including households, civic groups, community structures and other sectors to play an active rather than passive role in the health care system. While the SA Dept of Health has engaged in policy reforms to strengthen the system to have a more people-centred community orientation, there are gaps in knowledge about how best to practically achieve these reforms. To narrow this gap, the applicants have partnered with the KwaZulu-Natal (KZN) provincial Department of Health (DoH), to investigate how best to implement these reforms. To this end, we will conduct a formative investigation of the barriers, needs and opportunities for strengthening of the pillars of the health system to be enabling of a people-centred community orientation. This information will be used to inform the co-development (with the KZN DoH and other sectors) of conceptual models of how the pillars of the health system could be strengthened to be more enabling of a people-centred community orientation. Testing and refining of these conceptual models will form the basis of a full stage proposal.