CHESAI seeks to deepen research insights from research projects to generate cross-over insight by supporting issue, conceptual and methodological engagement across multiple research and capacity development projects.
The projects listed here are not funded by or through CHESAI, but are some of the projects that CHESAI colleagues were engaged in during the first phase of CHESAI’s work (2012-2016).
Resilient and Responsive Health Systems (RESYST)
Resilient and Responsive Health Systems (RESYST) is a Consortium that is undertaking health policy and systems research (with a focus on financing, health workers and governance) in a set of African and Asian settings, including India, Kenya, Nigeria, South Africa, Thailand, Tanzania and Vietnam. Funded by DfID, the consortium began in 2011 and will run until 2016. The Health Policy and Systems Division has a particular focus on the governance agenda within the RESYST programme of work.
Universal coverage in Tanzania and South Africa: monitoring and evaluating progress (UNITAS)
The UNITAS project focuses on monitoring and evaluating policy formulation and implementation processes aimed at achieving universal health coverage in South Africa and Tanzania. The project undertakes monitoring mainly at the district level, with some monitoring and evaluation at the national level. It aims to support implementation processes and will establish an ‘early warning system’ of implementation difficulties. The project runs from 2011 to 2015 and is funded by the European Union. It is a collaborative project with partners from the London School of Hygiene and Tropical Medicine, Ifakara Health Institute (in Tanzania), Institute of Tropical Medicine Antwerp (in Belgium), Centre for Health Policy, University of Witwatersrand and the Africa Centre in South Africa.
District Innovation, Action and Learning for Health System Development (DIALHS)
District and sub-district managers in the South African health system are charged with building, strengthening and managing health systems that implement national policy frameworks. At the same time they need to remain responsive to local needs and contexts, involve multiple actors in decision-making and inspire and motivate staff to be creative in delivering services in resource-constrained settings. This is a complex and complicated undertaking, and managers are often hamstrung by the constraints of existing systems while they themselves are not sufficiently well-equipped to navigate between high need, limited resources and inherent system complexity. The District Innovation, Action and Learning for Health System Development (DIALHS) project – funded by The Atlantic Philanthropies – is engaging with these challenges at the implementation level in the sub-district of Mitchell’s Plain in Cape Town. Comprising a partnership between the Schools of Public Health at UCT and UWC, as well as the health departments of the City of Cape Town and the provincial government of the Western Cape, the project aims to facilitate a better functioning, more responsive, more effective district health system (DHS). It intends to do this firstly, through better understanding the key restrainers and enablers of health system functioning at local level; and secondly, by jointly developing strategies and interventions which respond to the complex and layered nature of the health system.
Read the DIALHS Policy Briefs
Whole System Change in South Africa (WholeSystSA): 2015-2016
Understanding the experience of health system transformation in the Western Cape province. What public health system performance improvements has the Western Cape province achieved over the last 20 years, and what has enabled or constrained such improvements? The WholeSystSA grant will support formative research better to understand past experience - in order to inform future monitoring and evaluation activities of health system development in the Western Cape. It will compare the Western Cape experience with the wider national experience since 1994 drawing on the lessons generated by relevant, international evidence. WholeSystSA is a joint project between the Western Cape Department of Health, the University of Cape Town, the University of the Western Cape (and includes a steering committee made up of members from the Western Cape Department of Health, the Health Systems Trust, the Medical Research Council, and Stellenbosch University). The research-policy partnership is funded by the Health Systems Research Initiative (a LMIC health system strengthening funding consortium made up of the Wellcome Trust, ESRC, MRC and UKAID).
Engagement between the system and non-state providers in Ghana: 2015-2018
Researchers from the UCT-HPSD are engaged in a three year grant by the Alliance for Health Policy and Systems Research in the World Health Organisation (AHPSR-WHO), to conduct a historical case study of the evolution of the relationship between the non-state (faith-based) providers and the public health system in Ghana. This project will run from 2015-2018, and will be jointly conducted with researchers from the University of Ghana.
Assessing large-scale health systems intervention practice in Mozambique and Zambia: 2014-2016
A team from UCT are engaged in an evaluative research project running from 2014 to 2016, in which two large-scale health systems strengthening interventions are being assessed in Zambia and Mozambique – both funded by the Doris Duke Charitable Foundation. In this project we are working closely with colleagues in Mozambique and Zambia to add a qualitative and process evaluation of the health systems strengthening interventions, focused on health planning and management and primary level quality of care, respectively, they have introduced.
Partnership for Health Leadership and Management (PAHLM): 2014-2015
The UCT-HPSD is also involved in a partnership with the School of Public Health at the University of the Western Cape, the Division of Community Health Sciences at the University of Stellenbosch and the Western Cape Department of Health to develop a strategy to strengthen health leadership throughout all levels of the health system of the Western Cape Department of Health. The PAHLM project is part of an envisioned longer-term engagement between the three Higher education Institutions and the Provincial Department of Health, with the aim of contributing to leadership capacity development in a planned, co-ordinated and responsive way. It contributes significantly to the vision and goals of the Provincial Strategy of Health Care 2030, by nurturing and developing a cadre of leaders at all levels of the health system who hold stewardship of Health care 2030. The PAHLM work integrally links with the range of initiatives in the division around leadership and management strengthening.
Mainstreaming a health systems approach to delivery of maternal health services: transdisciplinary research in Rwanda and South Africa. 2013-2016
In a bid to support health systems research and strengthen human capacity development within the health sector in Rwanda and South Africa, the Netherlands Organization for Scientific Research / Science for Global Development (NWO/WOTRO), through its Global Health Policy and Health Systems Research Programme, has awarded a grant to a research consortium (Centre for Health Policy of Wits University, University of Western Cape School of Public Health, University of Rwanda) for the implementation of a research project entitled ‘Mainstreaming a health systems approach to delivery of maternal health services: transdisciplinary research in South Africa and Rwanda’. The research project aims to generate knowledge on how health systems strengthening can improve maternal health, and which health system supply and demand initiatives have the largest impact. Using a combination of systematic and realist reviews, secondary data analysis and primary data collection and analysis, the key components of health systems that countries currently prioritise in their efforts to improve maternal health are to be identified and tested in four sub-projects
Strengthening School Health services through health systems research and support
The UCT-HPSD has been involved in a number of projects and activities aimed at strengthening school health service (SHS) development and implementation in South Africa. The potential value of SHS is indisputable, but how this service is best located and implemented in, and supported by, the broader health system is the subject of ongoing enquiry. The HPSD has significant policy development and research experience in school health and is well-placed in bringing evidence to bear on the implementation of the Integrated School Health programme (ISHP).
A key project that the HPSD has been involved with over the past two years, through a subcontract by the Medical Research Council and in conjunction with other partners, was a CDC funded project to strengthen the implementation of the Integrated School Health Policy in a NHI pilot district in South Africa. This work aimed to use the innovations and lessons from the pilot site experience to inform school health implementation across the country. The project funding had subsequently been diverted to support a broader initiative for adolescent girls and the project team is currently their possible contribution to this new focus area.
Outputs from the two-year subcontract are: A review of mental health screening in school aged children across Africa-distilling lessons for the mental health component of the ISHP; and a review of community-linked models of school health services. The third review, originally intended to explore models of service provision for children with chronic health conditions in the school setting, will be extended to examine broader health systems implications of managing and supporting children with chronic health conditions across the age spectrum (0-18 years).
The HPSD is currently engaged in the Western Cape province in an evaluation of School Wellness mobiles, as well as in a province-wide initiative to rethink the design and implementation of school health services in this province.