A case study on the opportunities and constraints in the public health sector of Mpumalanga Province, South Africa.
New research explored how health officials in a rural province in South Africa can be innovative, efficient, and responsive to local conditions in service delivery.
Dr Lucia D'Ambruoso and her collaborators examined three, key dimensions of their ‘decision space’ - capacity, authority, and accountability - at different administrative levels of the health system. Findings revealed that while there is significant informal capacity and ingenuity at operational levels, accountability poses challenges, particularly due to a focus on bureaucratic compliance rather than empowering local leadership. Lines of authority are clear, enabling action across roles, but external accountability is limited mainly to communities, and internal mechanisms are weak.
The study recommends extending existing capacity through cooperative learning to enhance accountability and support local innovation and resilience. It suggests that hierarchical governance should better acknowledge and incorporate local-level innovations, promoting bottom-up learning and improved communication between district and provincial levels.
Read the publication: Witter S, van der Merwe M, Twine R, Mabetha D, Hove J, Tollman SM, D'Ambruoso, L. Opening decision spaces: a case study on the opportunities and constraints in the public health sector of Mpumalanga Province, South Africa. PLoS ONE 19(7): e0304775. https://doi.org/10.1371/journal.pone.0304775