The role of emergent champions in policy implementation for decentralised drug-resistant tuberculosis care in South Africa

Bibliographic Data

ID21878795
AuthorsSacha Roxanne Le Roux (0000-0002-0020-1414, University of Cape Town, corresponding author), Waasila Jassat (0000-0003-4279-3056, University of the Western Cape), Lindy Dickson (University of Cape Town), Leila Mitrani (0000-0001-5295-0591, University of Cape Town), Helen Cox (0000-0001-8949-9335, University of Cape Town), Koleka Mlisana (0000-0002-8436-3268, University of KwaZulu-Natal), John Black (0000-0002-9602-8416, University of Cape Town), Marian Loveday (0000-0001-9205-9314, South African Medical Research Council), Anne D Grant (0000-0002-2437-5195, University of the Witwatersrand), Alison D Grant, Mosa Moshabela (0000-0002-9438-7095, University of KwaZulu-Natal), Karina Kielmann (0000-0001-5519-1658, Queen Margaret University), Mark P Nicol (0000-0002-1366-4805, University of Cape Town)
Year2022
Volume7
Issue12
Pagese008907
Publication date2022-12-01
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2022-008907
PMID36593649
OpenAlexW4310920086
LanguageEN
Citations received4
References cited11

OBJECTIVE: Champions are recognised as important to driving organisational change in healthcare quality improvement initiatives in high-income settings. In low-income and middle-income countries with a high disease burden and constrained human resources, their role is highly relevant yet understudied. Within a broader study on policy implementation for decentralised drug-resistant tuberculosis care in South Africa, we characterised the role, strategies and organisational context of emergent policy champions. DESIGN: Interviews with 34 healthcare workers in three South African provinces identified the presence of individuals who had a strong influence on driving policy implementation forward. Additional interviews were conducted with 13 participants who were either identified as champions in phase II or were healthcare workers in facilities in which the champions operated. Thematic analyses using a socio-ecological framework further explored their strategies and the factors enabling or obstructing their agency. RESULTS: All champions occupied senior managerial posts and were accorded legitimacy and authority by their communities. 'Disease-centred' champions had a high level of clinical expertise and placed emphasis on clinical governance and clinical outcomes, while 'patient-centred' champions promoted pathways of care that would optimise patients' recovery while minimising disruption in other spheres of their lives. Both types of champions displayed high levels of resourcefulness and flexibility to adapt strategies to the resource-constrained organisational context. CONCLUSION: Policymakers can learn from champions' experiences regarding barriers and enablers to implementation to adapt policy. Research is needed to understand what factors can promote the sustainability of champion-led policy implementation, and to explore best management practices to support their initiatives

Business · Champion · Corporate governance · Economic growth · Economics · Health care · Management · Political science · Public relations · Qualitative research · Sociology · Thematic analysis · Community Health and Development · Global Maternal and Child Health · Health Policy Implementation Science

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