Collaborations through SARChI

The School of Public Health (SOPH) continues to receive significant national research funding from the Department of Science and Innovation/National Research Foundation (NRF) and the South African Medical Research Council (SAMRC). This funding has been principally in the form of funded research chairs (SARChI) and an Extra-Mural SAMRC Research Unit. The first SARChI Chair in Health Systems Complexity and Social Change was established in 2013 and is occupied by Prof Asha George. This was followed by the Extra-Mural SAMRC Research Unit (Health Services to Systems) in 2014 and a second SARChI Chair in Health Systems Governance held by Prof Helen Schneider.

These sources of core funding have allowed us to develop lines of enquiry attuned to our perspectives as embedded researchers situated in the Global South; to invest heavily in capacity building (particularly through our doctoral programme); to advance our collaborative activities through established initiatives such as CHESAI (the Collaboration for Health Systems Analysis and Innovation); and to mobilise additional funding and partnerships.

Mutual strengthening

The two SARChI chairs and the Extra-Mural Research Unit are fully integrated into the functioning of the SOPH in a mutually beneficial manner: the programmes leverage the considerable administrative and pedagogical infrastructure of the SOPH while the SARChI chairs help to support key strategic functions in the School.

Asha leads the School’s research domain, providing cross-cutting support that enables the SOPH to maintain its high level of research productivity; and, The South African Research Chair Initiative (SARChI) was established by the Department of Science and Technology (DST) and the National Research Foundation (NRF) as a strategic intervention to increase scientific research capacity through the development of human resources and the generation of new knowledge, empowering top talent to develop particular fields.

since 2017, Helen has convened, with Wolde Amde, a structured and increasingly successful doctoral programme (described elsewhere in this report). Given their core roles in the SOPH, we were delighted when both SARChIs and the Extra-Mural Research Unit were successfully reviewed and awarded new five-year cycles of funding during the reporting period. In addition, Helen’s SARChI was upgraded from a Tier 2 to a Tier 1 status. Both Asha and Helen have received NRF B-ratings, and in 2020 Asha featured in the list of ten researchers at UWC within the top 100,000 researchers globally, in terms of 2019 research citations. The themes of research and engagement Asha and Helen are pursuing in the next cycle advance a number of key areas that were consolidated or initiated during the 2019/20 biennium.

Collaborative governance

One strand of our work addresses the inter-related ideas of governance, bottom-up health system strengthening and universal health coverage. Building on a previous evaluation (‘3-feet’) – which brought together ideas of local health system strengthening (centred on the district and the sub-district) with programmatic and health outcomes – we are

evaluating the Mphatlalatsane Project, a multi-partner and comprehensive maternal and newborn care strengthening initiative in three provinces.

In this evaluation, we are specifically seeking to develop insights into the mechanisms of ‘mesolevel stewardship of quality improvement’, the local processes of leadership and governance that sustain gains in quality and outcomes in health systems such as South Africa’s. Working jointly with the SAMRC’s Health Systems Research Unit, we have finalised the design and begun the field work. This evaluation is complemented by the work of doctoral candidate Fidele Mukinda, which explored local accountability for maternal, neonatal and child health in a rural district. He documented a local health service context saturated with mechanisms and discourses of performance accountability, challenging the common mantra of low accountability amongst frontline providers. Mary Kinney is also undertaking doctoral research on how maternal and perinatal audits are undertaken and sustained over time in the Western Cape’s rural hospitals.

Ida Okeyo’s doctoral studies took forward the specific focus on collaborative governance, through her case study of the Western Cape’s area-based Whole of Society Approach (WoSA) to the ‘First Thousand Days’ of an infant’s life (see article on page 26). Our presentation of the findings to provincial and local government stakeholders in October 2020 has set the stage for a new phase of prospective research and engagement from 2021 on the governance of placebased, local intersectoral collaboration. The importance of community engagement and multi-sectoral action was also one of the multiple messages produced by the Lancet Commission on Child Health and the SDGs to which Asha George contributed. Along with embedded researchers in India and Pakistan, funders and UN agencies, Asha published a commentary on governance as being key for multi-sectoral action required to address the social determinants underpinning adolescent health. As with WoSA, this analysis forms the start of likely future agendas of work on the structural determinants of child and adolescent health.

Research priorities

These initiatives build knowledge on, and foreground, the vital importance of bottom-up health system strengthening as a necessary balance to the topdown and macro-level policy making – such as in the emerging national health insurance (NHI) reforms. In this regard we facilitated, together with the SAMRC, a process of research priority setting for universal health coverage that provided an holistic appraisal of multi-faceted and multi-disciplinary health policy and systems research needs in South Africa. A national poll, which was part of this process, rated research on leadership and governance as the top health system priority, followed by research on human resources for health. Following these discussions, Manya van Ryneveld completed and published a desk review of human resources for health governance in South Africa.

Beyond the SOPH – and South Africa

Helen and Asha’s organisational roles have extended considerably beyond the SOPH, however – and their engagements beyond the borders of South Africa. In November 2019 Helen chaired the Scientific Committee of the national Dialogue on Universal Health Coverage in South Africa, hosted by the

SAMRC; and in 2020 she chaired the Task Team on Research for the development of UWC’s new Institutional Operating Plan (2021-5). Going beyond South Africa, Helen has been active in a regional collaboration focusing on Community Health Systems (CHS). The bilateral NRF-Swedish Research Council networking grant allowed us to host two multicountry workshops, bringing together researchers from the universities of Zambia, Makerere, Western Cape, Cape Town, Muhimbili and Umeå (Sweden). The workshops were held at the Chaminuka Lodge in Lusaka and culminated in the formulation of research priorities and a Chaminuka Declaration of Values and Principles for Research on CHS. A special issue of the International Journal of Health Policy and Management is currently being co-edited by this collective and will appear in early 2022. This network has also been awarded follow-up funding from 2021. In 2020, Asha led a Memorandum of Understanding between the SOPH and the United Nations University’s International Institute of Global Health to jointly work on a Gender and Health Hub. Together we have led an open and participatory research agenda-setting process on gender and COVID-19, enlisting over 400 participants from primarily low- and middle-income country settings. The collaboration has also supported co-authorship with WHO authors of analysis articles in the British Medical Journal.

We have also been leading a stream of work on health systems drivers of coverage and equity for maternal and child health as part of Countdown 2030, a collaboration between academics and UN agencies. Analysis was undertaken on how the Global Financing Facility/ World Bank addresses adolescent health from a systems lens, based on planning documents for the first 11 recipient countries. This has spurred additional funding and interest in broadening content analysis of further cross-cutting topics on Global Financing Facility country planning documents. Asha is also on the Results Advisory Group for the Global Financing Facility. Both Helen and Asha serve on Scientific and Technical Advisory Committees/Groups of the WHO. Helen is on the STAC for the Alliance for Health Policy and Systems/ WHO, while Asha serves on the STAG for the Human Reproduction Program/ WHO. From 2018 to 2020 Asha has also served as the Chair of the Health Systems Global society.

SARChI funding also supports three post-doctoral fellows in the SOPH who are contributing to various research projects, developing capacity in teaching and supervision by contributing to our academic programme, and writing publications based on their PhD research.

Dr Michelle de Jong

(January 2019 - March 2021) Michelle’s background is in psychology and she obtained her PhD through the Journalism and Media Studies Department at Rhodes University. Her thesis explored discursive constructions of health and identity among young South African adults, paying particular attention to the influences of neoliberalism and consumer culture. At SOPH she is working on developing publications based on her PhD research, assisting with the Globalisation and Health course, and supporting research linked to the SARCHI on Health Systems, Complexity and Social Change.

Dr Solange Mianda

(July 2019 - current) Solange Miada is working on the evaluation of the Mphatlalatsane project, a QI/ system strengthening initiative for improved maternal, neonatal and reproductive health care in three catchment areas of the country. She completed her PhD at the University of KwaZulu-Natal in 2019, through a thesis which proposed a composite model of intervention for ensuring clinical leadership in the labour ward of district hospitals, towards the reduction of maternal and perinatal mortality in the era of SDGs.

Dr Henry Zakumumpa

(November 2019 - December 2020) Henry Zakumumpa completed his PhD in Health Systems from Makerere University (Uganda) in 2018. His research focused on the sustainability of ART scale-up implementation in Uganda’s health system. During his time with the SOPH. Henry focussed on case studies and manuscript publications on the comparative experiences between high and low absorption of PEPFAR-supported workers in Ugandan health districts.