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Table 1 Emerging subthemes per health system building block

From: Public health system challenges in the Free State, South Africa: a situation appraisal to inform health system strengthening

A priori theme

Emerging subtheme

Number of reports

Percent (n = 44)

Service delivery

Fragmentation of services

42

95.5

Poor quality of service

29

65.9

Infrastructure challenges

29

65.9

No institutional road signs

22

50.0

Poor security in the institutions

5

11.4

Poor referral system

2

4.5

Dysfunctional EMS

2

4.5

Healthcare workforce

Shortage of staff

39

88.6

Poor HRH management

38

86.4

RWOPS challenges

18

40.9

Shortage of accommodation for interns

20

45.5

Information

Poor information management

26

59.1

Medical products, vaccines and technologies

Dysfunctional ICT system

27

61.4

Shortage of resources/equipment

26

59.1

Pharmaceutical system challenges

23

52.3

Supply chain management challenges

8

18.2

Financing

Financial/cash flow challenges

39

88.6

OSD challenges

3

6.8

Leadership and governance

Risk to patient care

38

86.4

Poor leadership

29

65.9

Poor priority setting

27

61.4

Lack of governance structures

22

50.0

Lack of policy implementation

8

18.2

Non-appointment of hospital board members and clinic committee members

1

2.3