揭示地区卫生系统治理结构的运作和有效性：来自南非一个省份的观点。

Piercing the veil on the functioning and effectiveness of district health system governance structures: perspectives from a South African province.

机构信息

Department of Public Health Medicine, School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, 31 Bophelo Rd, Prinshof, Pretoria, South Africa.

Department of Community Health, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 27 St Andrew's Road, Parktown, 2193, South Africa.

出版信息

Health Res Policy Syst. 2023 Aug 31;21(1):89. doi: 10.1186/s12961-023-01044-z.

DOI:10.1186/s12961-023-01044-z

PMID:37653433

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10469879/

Abstract

BACKGROUND

Leadership and governance are critical for achieving universal health coverage (UHC). In South Africa, aspirations for UHC are expressed through the proposed National Health Insurance (NHI) system, which underscores the importance of primary health care, delivered through the district health system (DHS). Consequently, the aim of this study was to determine the existence of legislated District Health Councils (DHCs) in Gauteng Province (GP), and the perceptions of council members on the functioning and effectiveness of these structures.

METHODS

This was a mixed-methods, cross-sectional study in GP's five districts. The population of interest was members of existing governance structures who completed an electronic-self-administered questionnaire (SAQ). Using a seven-point Likert scale, the SAQ focuses on members' perceptions on the functioning and effectiveness of the governance structures. In-depth interviews with the chairpersons of the DHCs and its technical committees complemented the survey. STATA® 13 and thematic analysis were used to analyze the survey data and interviews respectively.

RESULTS

Only three districts had constituted DHCs. The survey response rate was 73%. The mean score for perceived functioning of the structures was 4.5 (SD = 0.7) and 4.8. (SD = 0.7) for perceived effectiveness. The interviews found that a collaborative district health development approach facilitated governance. In contrast, fraught inter-governmental relations fueled by the complexity of governing across two spheres of government, political differences, and contestations over limited resources constrained DHS governance. Both the survey and interviews identified gaps in accountability to communities.

CONCLUSION

In light of South Africa's move toward NHI, strengthening DHS governance is imperative. The governance gaps identified need to be addressed to ensure support for the implementation of UHC reforms.

摘要

背景

领导力和治理对于实现全民健康覆盖（UHC）至关重要。在南非，全民健康保险（NHI）制度表达了实现 UHC 的愿望，该制度强调了通过地区卫生系统（DHS）提供初级卫生保健的重要性。因此，本研究旨在确定在豪登省（GP）是否存在立法规定的地区卫生理事会（DHC），以及理事会成员对这些结构的运作和有效性的看法。

方法

这是一项在 GP 的五个地区进行的混合方法、横断面研究。研究对象是现有治理结构的成员，他们填写了电子自我管理问卷（SAQ）。SAQ 采用七点李克特量表，重点关注成员对治理结构运作和有效性的看法。对 DHC 及其技术委员会主席的深入访谈补充了调查。使用 STATA® 13 和主题分析分别对调查数据和访谈进行分析。

结果

只有三个地区成立了 DHC。调查的回复率为 73%。对结构运作的感知功能的平均得分为 4.5（SD=0.7）和 4.8（SD=0.7），对结构有效性的感知。访谈发现，协作的地区卫生发展方法促进了治理。相比之下，由两个政府层面的复杂治理、政治分歧以及对有限资源的争夺引发的紧张的政府间关系，限制了 DHS 的治理。调查和访谈都发现了对社区问责制的差距。