Making Systems Work

As part of a multi-country study, maternal health services were reviewed in one health district in Gauteng Province, South Africa. Poor record-keeping, inadequate supervision, poor levels of clinical knowledge and under-utilisation of midwife obstetric units were found. Interventions identified by local health service personnel to improve maternity care were developed, implemented and evaluated, included programme-specific (training in prevention of mother-to-child transmission of HIV and neonatal resuscitation) and system interventions (improving interpersonal relations and system functioning, use of routine data for monitoring purposes, improving supervision skills). This resulted in some positive outputs. Health worker knowledge and patient records improved, and there was some indication that supervision improved. However, system-wide interventions that could improve programmes were less successful. To build a learning organisation, a new culture of monitoring and evaluation, including routine self-evaluation, is required as core skills for all health workers. These data should be used at the point of collection. Changing reporting lines between programme and district managers may improve co-ordination between different authorities, and there is a need to enhance the manner in which staff are assessed, appraised, promoted and rewarded. Professional bodies who oversee training curricula, institutions that offer training, and institutions that provide funding for training and development need to take on the challenge of health systems development and avoid promoting programme-specific interventions only

Economic growth · Health care · Medical education · Psychological intervention · Child and Adolescent Health · Global Maternal and Child Health · Medicine · Nursing · Primary Care and Health Outcomes

• Innovation to improve health care provision and health systems in sub-Saharan Africa – Promoting agency in mid-level workers and district managers

  Open Access•Sharon Fonn, Sunanda Ray et al.•Global Public Health•2010

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• The macroeconomic environment and sexual and reproductive health

  Sharon Fonn, Tk Sundari Ravindran•Reproductive Health Matters•2011

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• The influence of health system organizational structure and culture on integration of health services

  Open Access•Mary Kawonga, Duane Blaauw et al.•Health Policy and Planning•2016

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• Act global, but think local

  Lynn P Freedman, Marta Schaaf•Reproductive Health Matters•2013

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• Sub-Saharan Africa and the health MDGs

  Fabienne Richard, David Hercot et al.•Reproductive Health Matters•2011

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• Activism

  Sunanda Ray, Farai Madzimbamuto et al.•Reproductive Health Matters•2012

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• Health Workers for Change as a health systems management and development tool

  Open Access•Carol Vlassoff, Sharon Fonn•Health Policy and Planning•2001

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• The Safe Motherhood Initiative

  Deborah Maine, Allan Rosenfield•American Journal of Public Health•1999

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