Whole System Change in South Africa: Understanding the experience of health system transformation in the Western Cape province (WholeSyst-SA). (360G-Wellcome-110319_Z_15_Z)

Over the last twenty years South Africa has implemented a broad array of changes within its health system in order to improve its ability to offer good quality health care at reasonable cost to vulnerable population groups. Whilst there is national recognition that performance improvements have fallen short of expectations, the Western Cape province is reputed to have performed relatively well. The proposed exploratory and formative research will examine this province's experience since 1994, comparing it with wider national experience and considering the lessons for future monitoring and evaluation of health system development, including related research needs. The project's objectives will be addressed through a sequenced set of data collection activities, comprising review of existing policy documents and research reports, elite interviews with policy-makers, and analysis of routinely collected health system data for the Western Cape and other provinces. The Western Cape experience will be set against wider national experience, including specific comparison with two other provinces which will be purposefully selected to allow reflection on insights generated by initial analysis of the Western Cape experience. The project will be guided and supported by a steering committee comprised of policy-makers, managers and researchers, who will together tease out wider lessons - including those concerning future provincial monitoring and evaluation activities. The project, therefore, is itself an example of the embedded research identified as important for health policy and systems research.