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

种族隔离制度结束20年后，评价南非卫生体制改革经验的时机已经成熟。承诺了很多，已经引入了许多变化--但已经取得了多少成就，特别是对于最脆弱和以前处于不利地位的群体？公共卫生系统被全国公认为改善弱势群体健康和福祉努力的前沿，哪些因素促成或限制了整个公共卫生系统的变革？过去的经验对继续努力改善卫生保健和健康有什么借鉴意义？需要随着时间的推移跟踪哪些问题，以产生支持未来政策和管理决策所需的证据？这项拟议的拨款旨在解决这些问题。该报告是由西开普省的一个公共卫生系统政策制定者/管理人员和研究人员团队联合提交的。由于南非是一个准联邦制国家，WC省政府在宪法上负有责任，确保其人口享有有效的卫生系统。它还享有在过去20年中在维持这种变革的实施方面相对有效的声誉。与更广泛的国家经验相比，审查一个省的具体经验将使人们能够深入调查南非卫生系统的变革。该项目不仅将考虑实施了哪些变化，取得了哪些成就和挑战，而且还将考虑哪些政治、领导、组织和其他因素支持或限制了变化的实施。从这一分析中，它将寻求确定作为该省卫生系统发展基础的变革路径。项目团队的经验和专业知识的结合将支持这一深入调查。根据国家背景，更好地了解该省取得了什么成就以及如何取得成就，将为全国乃至国际提供具有现实意义的见解。更具体地说，它还将通过支持各省卫生系统监测和评估活动以及确定相关的、更大规模的研究需求，帮助形成支持未来政策和管理决策所需的证据基础。

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.