District wide approach on ward based outreach teams in Mopani: an evaluation of the implementation process
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Date
2016
Authors
Madikizela, Lindiwe Fortunate
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Abstract
Integral to achieving country targets in health has been the introduction of the four
streams of PHC Re-engineering which include municipal Ward Based Outreach
Teams (WBOTs), Integrated School Health Teams, District Clinical Specialist Teams
(DCSTs) and Contracted Private Providers. The PHC Re-engineering strategy was
launched in South Africa in 2011. The Mopani District started implementation of
WBOTs in June 2013.
A retrospective qualitative case study was conducted to investigate the processes and
factors that facilitated WBOTs implementation in Mopani District. Also to evaluate the
alignment of the Mopani process to the Department of Health Guidelines for Provinces.
Using structured in-depth interviews, data was collected from WBOTs programme
implementers at the District, Sub-district and NGO level. Programme documents were
also used to gather information on the implementation and coverage from June 2013
to June 2015.
The implementation of WBOTs was simultaneously facilitated in all five sub-districts
with the guidance of DCSTs. There was consensus on the WBOTs implementation
process across all participants. The district achieved 73% ward coverage in two years
with 119 active functional WBOTs. Some deviation were reported in some sub-district
on the recruitment and selection of WBOTs. DCSTs were the main drivers of the
implementation. However, there was concern on the passive role of the sub-districts
on WBOTs implementation. Due to a lack of budget allocation, resources were a major
challenge resulting in frustration on the WBOTs support staff. Co-ordination and
governance of CHWs pose a challenge to the programme due to dual reporting and
unclear management of WBOTs. A slight deviations from the DoH guideline on
WBOTs implementation was observed but these were necessary to accommodate
contextual factors.
The research make practical recommendations to strengthen the implementation of
WBOTs at all levels.
Description
A research report submitted to the Faculty of
Health Sciences
University of the Witwatersrand, Johannesburg,
In partial fulfilment of the requirements for
degree of Master of Public Health
Date: 21 October 2016