Browsing by Author "Chitha, Wezile"

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    A qualitative study of the dissemination and diffusion of innovations: bottom up experiences of senior managers in three health districts in South Africa
    (2019-03-29) Orgill, Marsha; Gilson, Lucy; Chitha, Wezile; Michel, Janet; Erasmus, Ermin; Marchal, Bruno; Harris, Bronwyn
    Background In 2012 the South African National Department of Health (SA NDoH) set out, using a top down process, to implement several innovations in eleven health districts in order to test reforms to strengthen the district health system. The process of disseminating innovations began in 2012 and senior health managers in districts were expected to drive implementation. The research explored, from a bottom up perspective, how efforts by the National government to disseminate and diffuse innovations were experienced by district level senior managers and why some dissemination efforts were more enabling than others. Methods A multiple case study design comprising three cases was conducted. Data collection in 2012 – early 2014 included 38 interviews with provincial and district level managers as well as non- participant observation of meetings. The Greenhalgh et al. (Milbank Q 82(4):581-629, 2004) diffusion of innovations model was used to interpret dissemination and diffusion in the districts. Results Managers valued the national Minister of Health’s role as a champion in disseminating innovations via a road show and his personal participation in an induction programme for new hospital managers. The identification of a site coordinator in each pilot site was valued as this coordinator served as a central point of connection between networks up the hierarchy and horizontally in the district. Managers leveraged their own existing social networks in the districts and created synergies between new ideas and existing working practices to enable adoption by their staff. Managers also wanted to be part of processes that decide what should be strengthened in their districts and want clarity on: (1) the benefits of new innovations (2) total funding they will receive (3) their specific role in implementation and (4) the range of stakeholders involved. Conclusion Those driving reform processes from ‘the top’ must remember to develop well planned dissemination strategies that give lower-level managers relevant information and, as part of those strategies, provide ongoing opportunities for bottom up input into key decisions and processes. Managers in districts must be recognised as leaders of change, not only as implementers who are at the receiving end of dissemination strategies from those at the top. They are integral intermediaries between those at the at the coal face and national policies, managing long chains of dissemination and natural (often unpredictable) diffusion.
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    Exploring factors motivating health workers to choose and maintain a career in rural health practice in South Africa
    (2007) Chitha, Wezile; McIntyre, Di
    The South African National Department of Health (NDoH) has committed itself to ensure that there is equity in the distribution of health workers especially to rural areas primarily through service requirements and incentives. Despite all initiatives put in place, the national health system struggles to recruit and retain health workers in rural health system struggles to recruit and retain health workers in rural health facilities. While the majority of health workers choose to practise in urban areas, some choose to pursue and persist in a career in rural health practice. This study determines, in the South African context, factors that motivate health workers to choose and maintain a career in rural health practice. It establishes what makes health workers choose to work in rural areas, what encourages them to stay in rural health practice and what tempts them to leave rural health practice. These factors interact at different levels, at the level of an individual health worker, of a rural health organisation or level of a rural community, to influence the decision of a health worker to choose, stay in or leave rural health pratice. The study combines both quantitative and qualitative methods in a cross-sectional survey to identify these factors from the perspective of rural health workers. It invites rural health workers to identify those factors that are applicable to them from the list of factors and rank them according to the degree of importance in their decision-making. A self-administered structured questionnaire and key informant interviews were used to collect data. The findings of this study show that rural background, desire to gain work experience, family obligations, prior interest in underserved area practice, desire or requirement to perform community service, desire to live in a rural area, family friendly enviornment and having friends living in a rural area are very important factors motivating health workers to choose a career in rural health practice.