Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
BMJ Glob Health. 2021 Nov;6(11). doi: 10.1136/bmjgh-2021-006911.
Effective public financial management (PFM) ensures public health funds are used to deliver services in the best way possible. Given the global call for universal health coverage, and concerns about the management of public funds in many low-income and middle-income countries, PFM has become an important area of research. South Africa has a robust PFM framework, that is generally adhered to, and yet financial outcomes have remained poor. In this paper, we describe how a South African provincial department of health tried to strengthen its PFM processes by deploying finance managers into service delivery units, involving service delivery managers in the monthly finance meeting, using a weekly committee to review expenditure requests and starting a weekly managers' 'touch-base' meeting. We assess whether these strategies strengthened collaboration and trust and how this impacted on PFM.
This research used a case study design with ethnographic methods. Semi-structured interviews (n=30) were conducted with participant observations. Thematic analysis was used to identify emergent themes and collaborative public management theory was then used to frame the findings. The authors used reflexive methods, and member checking was conducted.
The deployment of staff and touch-base meeting illustrated the potential of multidisciplinary teams when members share power, and the importance of impartial leadership when trying to achieve consensus on how to prioritise resource use. However, the service delivery and finance managers did not manage to collaborate in the monthly finance meeting to develop realistic budgets, or to reprioritise expenditure when required. The resulting mistrust threatened to derail the other strategies, highlighting how critical trust is for collaboration.
Effective PFM requires authentic collaboration between service delivery and finance managers; formal processes alone will not achieve this. We recommend more opportunities for 'boundary crossing', embedding finance managers in service delivery units and impartial effective leadership.
有效的公共财政管理（PFM）确保公共卫生资金以最佳方式用于提供服务。鉴于全球对全民健康覆盖的呼吁，以及对许多低收入和中等收入国家公共资金管理的关注，PFM 已成为一个重要的研究领域。南非拥有健全的 PFM 框架，通常都能得到遵守，但财政成果仍然不佳。在本文中，我们描述了南非一个省级卫生部门如何通过将财务经理部署到服务提供单位、让服务提供经理参与每月的财务会议、使用每周委员会审查支出请求以及启动每周经理“联系”会议来加强其 PFM 流程。我们评估了这些策略是否加强了协作和信任，以及这对 PFM 产生了怎样的影响。
本研究采用案例研究设计和民族志方法。对 30 名参与者进行了半结构化访谈，并进行了观察。使用主题分析来确定新兴主题，然后使用协作公共管理理论来构建研究结果。作者使用了反思性方法，并进行了成员检查。
员工部署和“联系”会议说明了当成员共享权力时，多学科团队的潜力，以及在尝试就如何优先考虑资源使用达成共识时，公正领导的重要性。然而，服务提供和财务经理未能在每月的财务会议上协作制定现实的预算，也未能在需要时重新安排支出。由此产生的不信任威胁到了其他策略的实施，突出了信任对于协作的重要性。
有效的 PFM 需要服务提供和财务经理之间的真正协作；仅仅依靠正式流程是无法实现这一点的。我们建议提供更多的“跨界”机会，将财务经理嵌入服务提供单位，并提供公正有效的领导。
