Strengthening public financial management in the health sector
A qualitative case study from South Africa
Bibliographic Data
| ID | 21881067 |
|---|---|
| Authors | Jodi Wishnia (0000-0002-2525-6964, University of the Witwatersrand, corresponding author), Jane Goudge (0000-0001-6555-7510, University of the Witwatersrand) |
| Year | 2021 |
| Volume | 6 |
| Issue | 11 |
| Pages | e006911 |
| Publication date | 2021-11-01 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | BMJ Global Health (JOURNAL) |
| Journal identifiers | ISSN: 2059-7908 • E-ISSN: 2059-7908 |
| Publisher | BMJ (PUBLISHER • GB) |
| DOI | 10.1136/bmjgh-2021-006911 |
| PMID | 34728478 |
| OpenAlex | W3208619015 |
| Language | EN |
| Citations received | 1 |
| References cited | 26 |
INTRODUCTION: Effective public financial management (PFM) ensures public health funds are used to deliver services in the best way possible. Given the global call for universal health coverage, and concerns about the management of public funds in many low-income and middle-income countries, PFM has become an important area of research. South Africa has a robust PFM framework, that is generally adhered to, and yet financial outcomes have remained poor. In this paper, we describe how a South African provincial department of health tried to strengthen its PFM processes by deploying finance managers into service delivery units, involving service delivery managers in the monthly finance meeting, using a weekly committee to review expenditure requests and starting a weekly managers' 'touch-base' meeting. We assess whether these strategies strengthened collaboration and trust and how this impacted on PFM. METHOD: This research used a case study design with ethnographic methods. Semi-structured interviews (n=30) were conducted with participant observations. Thematic analysis was used to identify emergent themes and collaborative public management theory was then used to frame the findings. The authors used reflexive methods, and member checking was conducted. RESULTS: The deployment of staff and touch-base meeting illustrated the potential of multidisciplinary teams when members share power, and the importance of impartial leadership when trying to achieve consensus on how to prioritise resource use. However, the service delivery and finance managers did not manage to collaborate in the monthly finance meeting to develop realistic budgets, or to reprioritise expenditure when required. The resulting mistrust threatened to derail the other strategies, highlighting how critical trust is for collaboration. CONCLUSION: Effective PFM requires authentic collaboration between service delivery and finance managers; formal processes alone will not achieve this. We recommend more opportunities for 'boundary crossing', embedding finance managers in service delivery units and impartial effective leadership
Business · Economic growth · Economics · Financial management · Health care · Health services research · Political science · Public health · Public relations · Public sector · Qualitative research · Service delivery framework · Sociology · Thematic analysis · Global Maternal and Child Health · Healthcare Systems and Reforms · Medicine · Nursing · Public Policy and Administration Research · Finance · Marketing
Semistructured interviewing in primary care research
The health and health system of South Africa
Rethinking Decentralization
Trust in health care
Buchbesprechungen
Austerity, resilience and the management of actors in public hospitals
Impact of financial management centralisation in a health system under austerity
Does expanding fiscal space lead to improved funding of the health sector in developing countries
Organisational culture and trust as influences over the implementation of equity-oriented policy in two South African case study hospitals
An innovative leadership development initiative to support building everyday resilience in health systems
Collaborative Public Management
Exploring corruption in the South African health sector
The impacts of decentralization on health system equity, efficiency and resilience
Agency at the Managerial Interface
Big Questions in Public Network Management Research
Collaborative Public Management
Organizational Ethnographic Case Studies
| Unique citing works | 1 |
|---|---|
| Citations per year | 0,33 |
| Citation span | 2023 - 2023 (1) |
| Citation velocity | historical |
| Highly cited | No |
| Citation types | Neutral: 1 |