Implementation of district-based clinical specialist teams in South Africa: Analysing a new role in a transforming system

dc.contributor.authorOboirien, Kafayat
dc.contributor.authorHarris, Bronwyn
dc.contributor.authorGoudge, Jane
dc.contributor.authorEyles, John
dc.date.accessioned2025-05-26T07:53:08Z
dc.date.issued2018-08
dc.description.abstractBackground: Improving the quality of health care is a national priority in many countries to help reduce unacceptable levels of variation in health system practices, performance and outcomes. In 2012, South Africa introduced district-based clinical specialist teams (DCSTs) to enhance clinical governance at the lowest level of the health system. This paper examines the expectations and responses of local health system actors in the introduction and early implementation of this new DCST role. Methods: Between 2013 and 2015, we carried out 258 in-depth interviews and three focus group discussions with managers, implementers and intended beneficiaries of the DCST innovation. Data were collected in three districts using a theory of change approach for programme evaluation. We also embarked on role charting through policy document review. Guided by role theory, we analysed data thematically and compared findings across the three districts. Results: We found role ambiguity and conflict in the implementation of the new DCST role. Individual, organisational and systemic factors influenced actors’ expectations, behaviours, and adjustments to the new clinical governance role. Local contextual factors affected the composition and scope of DCSTs in each site, while leadership and accountability pathways shaped system adaptiveness across all three. Two key contributions emerge; firstly, the responsiveness of the system to an innovation requires time in planning, roll-out, phasing, and monitoring. Secondly, the interconnectedness of quality improvement processes adds complexity to innovation in clinical governance and may influence the (in) effectiveness of service delivery. Conclusion: Role ambiguity and conflict in the DCST role at a system-wide level suggests the need for effective management of implementation systems. Additionally, improving quality requires anticipating and addressing a shortage of inputs, including financing for additional staff and skills for health care delivery and careful integration of health care policy guidelines.
dc.description.sponsorshipEuropean Commissions’ Seventh Framework Programme (FP7-CP-SICA grant number 261349) .
dc.description.sponsorshipSouth African National Research Foundation (NRF).
dc.description.sponsorshipSouth African Department of Science and Technology (DST).
dc.description.sponsorshipSouth African Research Chair Initiative (SARChI) in Health Policy and Systems.
dc.description.sponsorshipResearch (Centre for Health Policy - Wits).
dc.description.submitterPM2025
dc.facultyFaculty of Health Sciences
dc.identifier0000-0003-0469-6431
dc.identifier0000-0001-6555-7510
dc.identifier.citationOboirien, K., Harris, B., Goudge, J. et al. Implementation of district-based clinical specialist teams in South Africa: Analysing a new role in a transforming system. BMC Health Serv Res 18, 600 (2018). https://doi.org/10.1186/s12913-018-3377-2
dc.identifier.issn1472-6963 (online)
dc.identifier.other10.1186/s12913-018-3377-2
dc.identifier.urihttps://hdl.handle.net/10539/44967
dc.journal.titleBMC Health Services Research
dc.language.isoen
dc.relation.ispartofseriesVol.18; a600
dc.rights© 2018 The Author(s) Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License.
dc.schoolSchool of Public Health
dc.subjectAdaptation
dc.subjectClinical governance
dc.subjectDCST(s)
dc.subjectImplementation
dc.subjectQuality improvement teams
dc.subjectRole
dc.subjectSouth Africa
dc.subject.primarysdgSDG-3: Good health and well-being
dc.titleImplementation of district-based clinical specialist teams in South Africa: Analysing a new role in a transforming system
dc.typeArticle

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