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A Case Study of Maternal Health Service Provision in OR Tambo District, Eastern Cape, in the Context of Chronic Poor Health Performance.

A Case Study of Maternal Health Service Provision in OR Tambo District, Eastern Cape, in the Context of Chronic Poor Health Performance.

Martina Lembani1, Helen de Pinho2, Peter Delobelle1, Christina Zarowsky1,3 Thubelihle Mathole1 & Alastair Ager2,4
1 School of Public Health, University of Western Cape, Cape Town, South Africa
2 Mailman Schools of Public Health, Columbia University, New York, USA
3 University of Montreal, Quebec, Canada
4 Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK

Health Systems Resilience: A Systems Analysis is a ReBUILD affiliate research project applying a systems dynamics approach to understand, predict and identify mechanisms that influence the resilience of health systems in contexts of adversity. The project is implemented by the Mailman School of Public Health, Columbia University, in collaboration with the School of Public Health, University of Western Cape.

Resilience is now a dominant concept underpinning development and humanitarian support in contexts vulnerable to crisis, including conflict. A series of three case studies were conducted for this project. The first, a historical analysis, considered measures addressing the disruption of HIV services in Cote d’Ivoire following the disputed presidential election of 20101. The second case study focused on circumstances in the health sector in the Yobe State, northern Nigeria, in response to the Boko Haram insurgency which began around 2011 and continues to the present day. This third case study focuses on a more chronic health systems failure in one province in South Africa – Eastern Cape, in OR Tambo District.

The paper makes a number of Key Points:

  • The Eastern Cape can be characterized as being in a state of ‘chronic emergency’ on technical, health systems, and socio-political levels
  • OR Tambo District reports among the poorest health and health service indicators in the country
  • A Group Model Building (GMB) approach to systems mapping assisted stakeholders in identifying key factors influencing maternal health service provision and the dynamics of their inter-connection
  • Participants further used the GMB process to identify leverage points to mobilize and coordinate resources to address chronic underperformance
  • District personnel prioritized leadership and team building, staff support and staff competence as issues within their scope of influence and authority to strengthen health systems performance
  • Model refinement highlighted interconnected balancing and reinforcing feedback loops which suggest, in systems terms, a basis for observed instances of higher-level performance within a generally underperforming health system

Read the full report: A Case Study of Maternal Health Service Provision in OR Tambo District, Eastern Cape, in the Context of Chronic Poor Health Performance.