Table 2 Building blocks, people, process, and policy shortfalls

Service delivery

Communities & staff unhappy about quality of services

• Long waiting times

• Medicines inadequate

• Facilities untidy

• Non-adherence to infection control measures

• Staff attitude negative

• Core standards not implemented & monitored

Health workforce

Staff dissatisfied with working conditions

• Critical vacancies

• Qualified staff not appropriately placed

• Staff work in ‘silos’

• Poor performance & evaluations

• Policies & delegations unknown & flouted

• Staffing norms not implemented

Information

Inadequate data capturers & unfilled posts

• Information services for monitoring trends unreliable & not used for planning & decision-making

• Insufficient access to hardware & connectivity in facilities

• Information management & information technology policies not adequate

Medicines, products & equipment

Staff non-compliant with stock taking & drug usage tracking

• Procurement processes inefficient

• Drug stocks ran out with no buffer stock

• Essential medical technology non-functional

• Stock orders not aligned to usage

• No stock tracking system in place

• Weak supply chain management policy & lack of monitoring by facility cost centres

Finance

Finance personnel lacked fiduciary responsibility

• Financial resources not allocated to impactful programmes

• Prioritised programmes not budgeted for

• Unfunded mandates prioritised

• Irregular & unauthorised expenditure incurred

• Weak financial management policies, delegations & practices

Leadership/governance

Lack of initiative & duty of care among senior managers

• No budget priorities

• Weak programme monitoring & reporting

• No coordination of policy & procedure

• Lack of accountability

• Financial & human resource delegations flouted

• Poor consequence management

• Weak referral policy & coordination