Table 3 Change mechanisms per health system building block
Building block | Change mechanism | How change was affected |
|---|---|---|
Service delivery | • Conduct process flow mapping & integration • Enforce compliance with norms & standards • Reconfigure service platform • Re-engineer patient admission (READ) • Re-engineer patient discharge (RED) • Complex district hospitals & cluster community health centres & primary health care clinics • Establish health posts in community • Reduce waiting times • Improve availability of medicines • Improve facility cleanliness • Improve infection control • Improve patient & staff safety • Improve staff attitudes • Improve Emergency Medical Services response times | • Managers developed flow maps • Compliance included as key performance area • Challenges in every section identified • Admission patterns & policies revised • Discharge patterns & policies revised • Patient-facility ratios considered • Health posts were included in infrastructure budget • Appointment system was introduced & staff increased • Common medicine procurement prioritised • Staff hiring & procurement of equipment & material expedited • Personal protective equipment procured & disinfection increased • Ward security & access control improved • Incentive scheme developed & incentives awarded • Tracking system installed on all ambulances |
Health workforce | • Fill vacant & critical vacancies • Appoint staff on merit & skill • Improve teamwork • Conduct workshops on policies & HR delegations • Enforce compliance & performance monitoring | • Critical posts identified & advertised • Staff job profiles & performance assessed • Constant team building exercises • Workshops scheduled & monitored • Key performance areas revised & monitored |
Information | • Maintain integrity of health information for monitoring trends, planning & decision-making • Improve access to internet connectivity in facilities & maintain 99% ‘uptime’ | • Internet connectivity installed & hardware bought • Reliable service provider was contracted |
Medical products, vaccines & technologies | • Improve supply chain management • Prevent drug stockouts & maintain buffer stock • Maintain essential medical technology • Align stock ordering with facility headcounts • Monitor implementation of stocktaking system | • Changed lead & turnaround times • Implemented daily stocktaking • Proactive maintenance programme developed • Alignment of stocks & numbers done • Weekly system-based stock level reporting introduced |
Financing | • Allocate financial resources for impactful programme implementation • Stop implementation of unfunded mandates • Implement prudent expenditure management practices | • Aligned the budget to prioritised strategic programmes • Implemented in-year monitoring & reporting • Implemented monthly expenditure reporting |
Leadership/governance | • Develop vision of organisation • Introduce priority setting linked to budget & organogram • Inculcate evidence-based decision-making • Foster monitoring & evaluation culture • Strengthen policy & procedure coordination • Consequence management for poor or failed implementation • Allocate & monitor implementation of financial & HR delegations • Implement inreach & outreach capacity-building programmes | • Vision analysed & changed • Strategy developed & linked to budget • Culture of management by risk implemented • Monthly feedback/reporting meetings introduced • Compliance to policy included as a key performance area • Deviations/exceptions reported & addressed • Role clarifications performed & delegations reviewed • Arrangements for inreach & outreach programmes made with relevant level managers |