Implementing health governance structures using participatory action research in a decentralised system

Abstract

This research was undertaken primarily to establish the challenges which impede the efficient and effective implementation of Health Governance Structures in South Africa. The study utilises Participatory Action Research methodologies to overcome implementation challenges in the North West Province of South Africa. Extant literature was reviewed to ascertain the gaps which have a major influence on the implementation of the Health Governance Structures. It was established during the literature review that community participation is widely accepted as a desirable feature of any health system. It is considered to be an important aspect of developing and fostering effective governance at various levels of the health system (Boulier, 2007). Good governance has been a fundamental tenet of South African health care since the advent of democracy in South Africa . The National Health (Act No. 61 of 2003), makes provision for formally-constituted , broad-based governance structures which include community representation at various levels of health care service delivery. It has been confirmed by varied literature that although efforts aimed at improving service delivery in the civil service is a universal concern , it is of particular importance in developing countries because of the crucial role that civil servants play in developmental endeavours. Effective governance of the health system is critical to ensure both access to quality health services and accountability about the health services to communities. The study was conducted utilising the Participatory Action Research (PAR) method. In the first phase of the Participatory Action Research , quantitative data was collected as a baseline of the problem. During the second phase of the research, reflective diaries and participation observation were used by focus groups and the researcher to collect data. This adopted method provided Health Governance Structures and managers of the Department of Health new opportunities to reflect on and assess their performance; to explore and test new ideas, methods, policies and guidelines; to assess how effective the new approach was; to share feedback with fellow team members and to make informed decisions about which new approaches should be included in the practice of managing Health Governance Structures. Participants collectively analysed qualitative data applying themes and coding. They ultimately developed an Action Plan which was later implemented and evaluated. The research revealed that major factors that mitigate against effective decentralisation in the decentralised health system include inadequate funds, lack of qualified personnel, inadequate logistics and equipment, poor interpersonal relationships, lack of transparency and a high rate of illiteracy (Sakyi, et al., 2011 ). This study has demonstrated that a PAR approach can be successfully utilised as an instrument to transform the manner in which service is being rendered to the community by the Department of Health , with the involvement of the communities. The aim of the research was not only to build theory but to address serious challenges that existed when implementing the Health Governance Structures (HGS) and to ensure that there is improvement in the manner health care is delivered in the North West Province. Most participants appreciated this exercise. It has not only enhanced the participants' knowledge and understanding about the challenges of each focus group but also enriched professional and community practices of each and informs best practices henceforth.