Implementation of health management systems in Department of Health primary health care facilities in uMkhanyakude District, KwaZulu-Natal.

Doctoral Degree. University of KwaZulu-Natal, Durban.South Africa, as in many other countries, has had challenges attaining health outcomes, and has attributed this to weak health systems. Management strengthening has been prioritised as a critical entry point and core element towards strengthening the health system. Poor management of primary health care facilities has been identified as a major challenge to improving quality of health services. The study aimed to examine the role played by Operational Managers (OMs) on the implementation of health management systems at primary health care facilities in the uMkhanyakude Health District in the Province of KwaZulu-Natal. The World Health Organisation’s conceptual frameworks for health systems performance systems, General Systems theory and Contingency theory were used as lenses to support the study. This study was exploratory in nature, and conducted through qualitative research methodology wherein OMs and primary health care Supervisors/Managers as the line managers of OMs in 56 primary health care facilities in the KZN DoH, uMkhanyakude Health District were purposively selected and interviewed through semi-structured in-depth interviews. The findings included that most management decisions, including planning, budget planning, workforce planning, supply chain and financial management, are centralised and controlled at the sub-district level, hence OMs play an insignificant role. OMs are not involved in planning, budgeting, and management of expenditure, management of supply chain or maintenance. The inadequate support and mentorship, lack of management training, ineffective centralised management systems, shortage of staff and too many programmes make it impossible for OMs to successfully implement their management functions, leading to a weak health system. It is recommended that the inputs and suggestions of OMs must be sought or they must be partially involved in critical decision-making as they are responsible for management of operations at this level. A systemic thinking approach when formulating management strengthening interventions will ensure that the focus is on resolving challenges across all management components and will strengthen the entire health system.No IsiZulu abstrac