District wide approach on ward based outreach teams in Mopani: an evaluation of the implementation process

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.