Implementing an intervention to improve leadership/management of public healthcare services in the Free State Province, South Africa: lessons learned.

BACKGROUND

Based on the World Health Organization's health systems strengthening framework, the Health Systems Governance and Accountability (HSGA) intervention to strengthen public health leadership/management, service integration and outcomes was developed in the Free State.

OBJECTIVES

This study describes the process to implement and measure the effects of the HSGA intervention for system-wide improvement of leadership/management under routine conditions in a resource-constrained setting.

METHODS

Based on normalisation process theory, participatory discussions were held with health managers, staff and local stakeholders to attain buy-in. Evaluation of the implementation process considered progress in improving leadership/management through application of the Balanced Scorecard (BSC). All provincial reporting units were assessed during 2014/15 and again during 2015/16.

RESULTS

The mean scores on three BSC perspectives improved statistically significantly from 2014/15 to 2015/16: customer (=0.0085), internal business processes (0.0008) and finance (=0.0001). Overall leadership/management also improved significantly (=0.0007).

CONCLUSION

Improvement in leadership/management resulting from implementation of the HSGA intervention was observed during the two years under study. From this experience, successful implementation of a health systems strengthening intervention hinges on a participatory design, appropriate use of theory, as well as application of an evaluation approach to assess the success of implementation.