Service Delivery Reform Research Articles

Examining sustained sub-national health system development: experience from the Western Cape Province, South Africa, 1994-2016.

Governance and leadership are recognized as central to health system development in low- and middle-income countries, yet few existing studies consider the influence of multilevel governance systems. South Africa is one of the many (quasi-)federal states. Provincial governments have responsibility for managing health care delivery within national policy frameworks and norms. The early post-apartheid period saw country-wide efforts to address the apartheid legacy of health system inequity and inefficiency, but health system transformation subsequently stalled in many provinces. In contrast, the Western Cape provincial health department sustained service delivery reform and strengthened management processes over the period 1994-2016. This department can be considered a 'pocket of relative bureaucratic effectiveness': an organizational entity that, compared to others, is relatively effective in carrying out its functions in pursuit of the public good. This paper considers what factors enabled the development of the Western Cape health system in the period 1994-2016. Two phases of data collection entailed document review, participatory workshops, 43 in-depth interviews with purposively selected key informants from inside and outside the Western Cape and a structured survey testing initial insights (response rate 42%). Analysis included triangulation across data sets, comparison between the Western Cape and other provincial experience and deeper reflection on these experiences drawing on POE theory and public administration literature. The analysis highlights the Western Cape experience of stable and astute sub-national governance and leadership and the deepening of administrative and technical capacity over time-within a specific provincial historical and political economy context that sustained the separation of political and administrative powers. Multilevel governance systems can create the space for sub-national POEs to emerge in their mediation of wider political economy forces, generating spaces for skilled reform leaders to act in the public interest, support the emergence of distributed leadership and develop robust management processes.

Women’s autonomy and maternal health decision making in Kenya: implications for service delivery reform - a qualitative study

BackgroundMaternal and neonatal outcomes in, Kakamega County is characterized by a maternal mortality rate of 316 per 100,000 live births and a neonatal mortality rate of 19 per 1,000 live births. In 2018, approximately 70,000 births occurred in the county, with 35% at home, 28% in primary care facilities, and 37% in hospitals. A maternal and child health service delivery redesign (SDR) that aims to reorganize maternal and newborn health services is being implemented in Kakamega County in Kenya to improve the progress of these indicators. Research has shown that women’s ability to make decisions (voice, agency, and autonomy) is critical for gender equality, empowerment and an important determinant of access and utilization. As part of the Kakamega SDR process evaluation, this study sought to understand women’s processes of decision-making in seeking maternal health care and how these affect women’s ability to access and use antenatal, delivery, and post-natal services.MethodsWe adapted the International Centre for Research on Women (ICRW) conceptual framework for reproductive empowerment to focus on the interrelated concepts of “female autonomy”, and “women’s agency” with the latter incorporating ‘voice’, ‘choice’ and ‘power’. Our adaptation did not consider the influence of sexual relationships and leadership on SRH decision-making. We conducted key informant interviews, in-depth interviews, small group interviews and focus group discussions with pregnant women attending Antenatal clinics, women who had delivered, women attending post-natal clinics, and men in Kakamega County. A thematic analysis approach was used to analyze the data in NVivo 12.ResultsThe results revealed notable findings across three dimensions of agency. Women with previous birthing experiences, high self-esteem, and support from their social networks exhibited greater agency. Additionally, positive previous birthing experiences were associated with increased confidence in making reproductive health choices. Women who had control over financial resources and experienced respectful communication with their partners exhibited higher levels of agency within their households. Distance relational agency demonstrated the impact of health system factors and socio-cultural norms on women’s agency and autonomy. Finally, women who faced barriers such as long waiting times or limited staff availability experienced reduced agency in seeking healthcare.ConclusionsIndividual agency, immediate relational agency, and distance relational agency all play crucial roles in shaping women’s decision-making power and control over their utilization of maternal health services. This study offers valuable insights that can guide the ongoing implementation of an innovative service delivery redesign model, emphasizing the critical need for developing context-specific strategies to promote women’s voices for sustained use.

Child health nurses' perceptions of the Family Community-based Assistance Resourcing and Education program in contemporary practice: a qualitative study.

The Family Community-based Assistance Resourcing and Education Program (FCP) is a nurse home visiting program that was introduced in Queensland two decades ago to redress health inequalities for infants from families experiencing specific social stressors. Locally adapted versions of this home visiting program are still in use, but have not been evaluated. This study examined child health nurse perceptions of the adapted FCP in one regional Queensland health service. A qualitative descriptive exploratory study using two focus groups (conducted May 2019) with Child Health Nurses who delivered the FCP was conducted. Transcripts of digital recordings were analysed using Braun and Clarke's (2006) six-step framework for guided thematic analysis. A total of 16 Child Health Nurses participated in the study, with a mean of 10years' experience with the program. Data analysis generated 12 themes organised under three domains: 'Establishing the relationship with families', 'What works in practice' and 'We could do it better'. Participants cited flexibility, expert input and in-home delivery as key program benefits. However, narrow eligibility criteria, poor screening for perinatal anxiety and resourcing constraints were identified as limitations. This study is the first to measure Child Health Nurses' perceptions of an adapted FCP. It sheds light on their 'practice wisdom', including the program's ability to meet the needs of families with social vulnerabilities. The study supports prior calls for home visiting programs to be evaluated against clearly stated program intentions. Participant insights have been shared to inform practice and program implementation both locally and as part of Queensland's First 2000Days health service delivery reform agenda.

Effect of Service Delivery Reforms on Access to Electricity in Rural Kenya

Background: Access to electricity in rural areas is critical for beneficiary households, local communities, and the economy as a whole. Indeed, access to electricity is one of the factors that will determine the realization of Kenya’s Vision 2030. In view of this, the Kenyan government has over the years, through regulatory bodies such as the Rural Electrification Authority, the Energy and Petroleum Regulatory Authority, and Kenya Electric Power, implemented various institutional and service delivery reforms to accelerate electricity adoption in rural areas. Objective: The study investigated the effect of service delivery reforms on access to electricity in rural Kenya. Methodology: The materials used in this study was part of the larger study that was looking at the effect of regulatory reforms in the electricity subsector on access to electricity in rural Kenya. In this paper, we present data generated from the quantitative component of the study that comprised 384 rural households in Kakamega, Uasin Gishu and Nyandarua counties. Data were collected using a questionnaire and analyzed by both descriptive and regression techniques. Findings: The study found that service delivery reforms notably; Stima Loans and Umeme Pamoja schemes as alternative ways of financing access to electricity, have no statistically significant association with access to electricity in the study areas. The results further indicate that most households (69.6%) do not have knowledge about these service delivery reforms. Conclusion: We have highlighted that most rural residents in the surveyed counties do not know of existing alternative ways to finance their access to electricity. Therefore, we suggest an increase in the awareness of rural residents about the existence and availability of these financing schemes to finance accelerate rural electrification in Kenya.

Political Economy of Non-Communicable Disease (NCD) prevention and control in Lebanon: identifying challenges and opportunities for policy change and care provision reforms

IntroductionLebanon is a middle-income country facing substantial fragility features. Its health profile shows a high burden of NCD morbidity and mortality. This paper intends to analyse the political economy of NCD prevention and control in Lebanon.MethodsThis study adopted a literature-based case study research design using a problem-driven political economy analysis framework. A total of 94 peer-reviewed articles and documents from the grey literature published before June 2019 were retrieved and analysed.ResultsLebanon’s political instability and fragile governance negatively affect its capacity to adapt a Health-in-All-Policies approach to NCD prevention and enable the blocking of NCD prevention policies by opposed stakeholders. Recent economic crises limit the fiscal capacity to address health financing issues and resulting health inequities. NCD care provision is twisted by powerful stakeholders towards a hospital-centred model with a powerful private sector. Stakeholders like the MOPH, UN agencies, and NGOs have been pushing towards changing the existing care model towards a primary care model. An incremental reform has been adopted to strengthen a network of primary care centres, support them with health technologies and improve the quality of primary care services. Nevertheless, outpatient services that are covered by other public funds remain specialist-led without much institutional regulation.ConclusionOur study revealed a locked equilibrium in NCD prevention policymaking in Lebanon, but with an incremental progress in service delivery reforms towards a primary care model. Advocacy and close monitoring by policy entrepreneurs (such as civil society) could initiate and sustain the implementation of policy change and care model reforms.

Coordinating external assistance forUHC: Pakistan's early experience ofthe SDG3 GAP.

Pakistan is a lower middle-income setting. External assistance for health and development partners play an important role in health sector development. The federal system and health care delivery as a devolved provincial subject warrant regular and effective coordination among federating units and partners. Pakistan was selected as a priority country in 2019 for the implementation of the Global Action Plan for Healthy Lives and Well-being for All (SDG3 GAP). Given the ongoing universal health coverage (UHC) reforms, the country prioritized two SDG3 GAP accelerators, related to primary health care (PHC) and sustainable financing for health (SFH). Eight partner agencies representing PHC and SFH accelerators jointly planned and conducted a 'PHC for UHC mission' to Pakistan in 2021. This mission paved the way for setting up an SDG3 GAP Coordination Committee and a 'PHC Service Delivery and Financing working group', which have been regularly coming together through in-person and virtual meetings; the latter was relatively uncommon previously and this new way of working provided a chance to build rapport, share workplans, identify duplications in technical assistance and jointly gauge governments' priorities. This has shifted the focus of reforms deliberations from 'what' to 'how', enabling joint strategic planning and implementation. The joint work by SDG3 GAP partners with the Ministry of National Health Services Regulation & Coordination linked discussions on health financing and service delivery reforms for the first time, and has contributed to advocacy, analysis, strategic policy dialogue, institutional strengthening and implementation of UHC reforms, with a focus on PHC. Even though joint work by SDG3 GAP partners undoubtedly shows the potential for better alignment and collaboration, translation of the commitment to better collaboration into concrete impact has been the result of committed and engaged staff members, rather than institutionalized change, which will require strong incentives for collaboration.

Appraising two decades of public sector health financing and service delivery reforms in Ghana between 2000-2020: a scoping review protocol (Preprint)

Appraising two decades of public sector health financing and service delivery reforms in Ghana between 2000-2020: a scoping review protocol (Preprint)

New public sector management (NPM) doctrines and service delivery: the case of Mauritius

PurposeThe purpose of this study is to investigate into the perception of new public sector management (NPM) and service delivery among senior officers of the Mauritian public sector in the context of reforms. Although improved service delivery is one of the salient outcomes of successful reforms of NPM, many governments in the world have not been able to fulfil this promise. While few extant research probe into the factors affecting service delivery, mostly from the customer’s perspective, this study probes into how senior public officers themselves perceive service delivery as part of their duty in government.Design/methodology/approachThe qualitative stance was adopted for this study. Interviews were conducted with 23 senior public officers having on average 20 years of service in the Mauritian public sector. Data obtained was transcribed and coded under themes, sub-themes and emergent themes. These were then analysed in the light of the literature review conducted.FindingsThe findings of this study revealed that NPM was being practiced and service delivery was an imbedded factor among senior public sector officers of the Mauritian public sector. Among other factors, officers interviewed were of the opinion that serving the public was a legitimate part of their job, view that they had agreed to serve the government of Mauritius. Such a finding proves to be very encouraging for the Mauritian Government, still struggling to achieve reforms or NPM doctrines.Research limitations/implicationsThis study contributes to the scant literature on NPM and service delivery in small island developing states. It explores the perception of experienced senior officers about the practice of NPM and the state of service delivery.Practical implicationsThis study elucidates how senior public servants themselves perceive service delivery and can, thus, serve as an example of public sector best practices in small island developing states.Originality/valueWhile most studies with respect to public sector reforms concentrate on developed countries, this study takes place in the small island state of Mauritius. More so, the perception of public servants themselves have been explored in the context of service delivery improvement and reforms, contrary to other studies which concentrate of the customers’ perceptions.

Service delivery reform for maternal and newborn health in Kakamega County, Kenya: study protocol for a prospective impact evaluation and implementation science study

BackgroundMaternal and neonatal mortality remain elevated in low and middle income countries, and progress is slower than needed to achieve the Sustainable Development Goals. Existing strategies appear to be insufficient. One proposed alternative strategy, Service Delivery Redesign for Maternal and Neonatal Health (SDR), centers on strengthening higher level health facilities to provide rapid, definitive care in case of delivery and post-natal complications, and then promoting delivery in these hospitals, rather than in primary care facilities. However to date, SDR has not been piloted or evaluated.MethodsWe will use a prospective, non-randomized stepped-wedge design to evaluate the effectiveness and implementation of Service Delivery Redesign for Maternal and Neonatal Health in Kakamega County, Kenya.DiscussionThis protocol describes a hybrid effectiveness/implementation evaluation study with an adaptive design. The impact evaluation (“effectiveness”) study focuses on maternal and newborn health outcomes, and will be accompanied by an implementation evaluation focused on program reach, adoption, and fidelity.

Policy by Pilot? Learning From Demonstration Projects for Integrated Care Comment on "Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study".

Analysis of policy implementation for chronic disease in Belgium highlights the difficulties of launching experiments for integrated care in a health system with fragmented governance. It also entreats us to consider the inherent challenges of piloting integrated care for chronic disease. Sociomedical characteristics of chronic disease -political, social, and economic aspects of improving outcomes - pose distinct problems for pilot projects, particularly because addressing health inequity requires collaboration across health and social sectors and a long-term, life-course perspective on health. Drawing on recent US experience with demonstration projects for health service delivery reform and on chronic disease research, I discuss constraints of and lessons from pilot projects. The policy learning from pilots lies beyond their technical evaluative yield. Pilot projects can evince political and social challenges to achieving integrated chronic disease care, and can illuminate overlooked perspectives, such as those of community-based organizations (CBOs), thereby potentially extending the terms of policy debate.

Healthcare leadership effectiveness among managers in Public Health institutions of Addis Ababa, Central Ethiopia: a mixed methods study

BackgroundLeadership is the ability to influence the attitudes, beliefs, and abilities of employees to achieve organisational goals. It is crucial for the successes or failures of organisational performance. Healthcare organizations need effective leadership to manage the health service delivery reforms efficiently and effectively. However, there was no adequate evidence on the current status of the healthcare leaders to make evidence-based decisions. Therefore, this study aims to assess the effectiveness of healthcare leadership and associated factors among managers working at public health institutions in Addis Ababa, Ethiopia.MethodsInstitution-based cross-sectional study triangulated with the qualitative study was employed from 01 April to 01 June 2021. A total sample of 844 healthcare managers were used to assess their leadership effectiveness. Multi-stage sampling followed by a simple random sampling technique was used to select the participants. Binary logistic regression model was fitted to identify the factors associated with healthcare leadership effectiveness. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-value less than 0.05 during multivariable logistic regression were used to declare the factors associated with the outcome variable. We conducted key informant interviews (KIIs) to explore the views of healthcare managers on their leadership practices, mainly on vision creation, developing followership and implementing vision. We also tape-recorded the KIIs and then transcribed word by word and finally translated it into English. We conducted a thematic analysis to supplement the quantitative findings.ResultsIn this study, 46.8% (95% CI: 43.4 -50.2) of the participants had effective healthcare leadership practices. Emotional intelligence (AOR = 7.86; 95% CI; 4.56, 13.56), democratic managers (AOR = 4.01, 95% CI; 1.98, 8.14), master or above education (AOR = 5.1; 95% CI; 2.07, 12.61) and work experience (AOR = 3.44, 95% CI; 1.24, 9.55) were positively associated with healthcare effective leadership. The challenges in healthcare leadership were mainly associated with lack of leadership knowledge and skills. In addition, autocratic leaders negatively influenced managers ability to work closely with the staffs and affected employee’s motivation. On the contrary, emotionally intelligent managers were effective on employee handling, providing chance to talk, understanding their feelings and needs.ConclusionHealthcare managers had low capacity on vision creation, implementation and developing followership, particularly the ability of vision creation was very low. Lack of leadership knowledge and skills and frequent use of autocratic leadership were the challenges for healthcare leadership effectiveness. This could also negatively influence organisational performances, managers’ ability to work closely with the staffs and reduced employee’s motivation. Therefore, strengthening emotional intelligence and empowering managers will be very helpful to improve leading health cares.

Public management in turbulent times: COVID‐19 as an ecosystem disruptor

The decentralisation of Swedish healthcare closer to citizens has been slow. Drawing from empirical material of the reform prior and amidst the COVID‐19 pandemic, this paper argues that the pandemic has disrupted the healthcare ecosystem. Consequently, citizen‐centred collaborations have accelerated integration of resources (such as knowledge and skills) across organisational, hierarchical and professional borders. However, collaborations have been delimited to traditional healthcare providers, neglecting the resources of citizens and other actors to be used to improve service delivery. The pandemic has revealed strengths and weaknesses with the prevailing healthcare ecosystem that post‐COVID‐19 public management must address, both theoretically and practically. Theoretically, the paper contributes to the development of a public service logic, addressing both strengths and difficulties with the logic in turbulent times. Practically, the empirical descriptions contribute to improved understanding of public service delivery reform and how it is impacted during the pandemic.

Service Delivery Reforms for Asian Ageing Societies: A Cross-Country Study Between Japan, South Korea, China, Thailand, Indonesia, and the Philippines.

Introduction:Japan’s health policies to address the most advanced-aged society have been the target of focus in Asia, but no studies have investigated this issue using tools for cross-country comparisons.Theory and methods:A cross-country study design was used to compare healthcare reform policies with a framework in Japan, Korea, Thailand, China, Indonesia, and the Philippines. Data were collected via document reviews and key informant interviews.Results:Three distinctions were identified. First, all countries except for the Philippines have policy decisions regarding reforms for the existing service delivery systems for healthcare, long-term care and welfare. Second, the most extensive service delivery reform is currently being implemented in Japan, whose system is shifting to primary health care. Third, the direction of the transformation of service delivery system is different between Thailand and China despite a similar level of ageing society. China has made progress on facility-based care integration between health and social care, whereas Thailand is focusing on home-based care.Conclusions and discussion:Doctor and hospital-based healthcare delivery system requires more drastic reform for an aged society. This fact implies that strengthening primary health care is not only useful for current health issues but also an investment for the aged society near future in low- and middle-income countries.

An ecological approach to understanding stroke experience and access to rehabilitation services in Ghana: A cross-sectional study.

Despite a growing burden of stroke in low-middle-income countries, research on patient's experiences and access to rehabilitation services remains limited. This study explores the experiences of stroke patients in relation to access and use of stroke rehabilitation services, coping strategies and strategies to improve care in Ghana. A cross-sectional study was conducted. A total of 136 adult stroke patients hospitalised and subsequently discharged in three major referral hospitals in Ghana participated in the study. A paper-based questionnaire was used to collect data. Data were inputted into STATA version 12, cleaned and analysed using descriptive statistics and Chi-Square tests. Findings showed that stroke patients experience stroke differently. Early detection (awareness) of stroke symptoms at onset was low (29.4%). Hypertension was the major (58.1%) predisposing risk factor for stroke, followed by diabetes (14.7%). Multiple barriers impede access to outpatient rehabilitation services: high cost of medications (43.4%), transportation constraints (10.3%), long waiting time (6.6%), forgetfulness about appointment (4.4%), limited education on rehabilitation (20.6%), lack of community support (12.5%) and ineffective communication with healthcare providers (5.2%). Recommended strategies to improve access to rehabilitation care included public education on stroke and its associated risk, reduction in the cost of drugs and increased stroke rehabilitation funding by the NHIS, especially for physiotherapy consultation and training support to caregivers on patient care. Given the difference in stroke experience and barriers in accessing rehabilitation care, multi-level health policy and service delivery reforms are needed to improve access to rehabilitation care, including national public awareness campaigns on early signs of stroke and subsidised cost of stroke rehabilitation.

Police Reform Practices and Service Delivery in the Kenya Police Service at Machakos County Police Headquarters, Kenya

This study focused on Police Reforms Practices and Service Delivery in the Kenya Police Service at Machakos County Police Headquarters. Police reforms in Kenya as availed from literature indicate that the colonial government in 1950 made attempts on reforming the police force. The appointment of the National Task Force on Police Reforms arose mainly from the post-election violence in 2007-2008 where hundreds of Kenyans lost their lives, thousands of people were displaced and property destroyed. This is because the police officers used excessive force, they were not trained to handle the violence that erupted and they took political sides. In order to address these concerns, the study aimed at examining police reforms practices and service delivery at Machakos county headquarters. Service delivery is a component of business that defines the interaction between providers and clients. Good service delivery provides clients with an increase in value. A well-functioning public sector that delivers quality public services consistent with citizen preferences and that fosters private market-led growth. The specific objectives were to establish the effect of personnel reforms and service delivery, establish the effect of financial reforms on service delivery and to establish the effect of legal reforms and service delivery in the Kenya Police service at Machakos County Police Headquarters Kenya. The significance of the study is as it tackled and documented the effect of police reforms practices and service delivery. It highlights the effect of personnel reforms and service deliver, financial reforms and service delivery and the legal reforms and legal reforms and service deliver. The study was guided by the Resource Based Theory, Servqual theory and the New Public Management Model in analyzing the theoretical background. A descriptive survey research design was used. The study targeted a population of 110 senior police officers in the Kenya Police Service and adopted the census approach to obtain information from every member of the population. Primary data was collected using a semi structured questionnaire, while secondary data was collected through review of literature on police reforms. Pilot study was conducted to validate the questionnaire. Data collected was subjected to quantitative analysis and data was presented using tables, graphs and pie charts inferential statistics was used in the study including correlation and multiple regressions in order to determine the relationship between the independent and dependent variables. Statistical package for social sciences (SPSS) version 22 was used to aid the analysis of the data. The findings revealed that personnel reforms and service deliver, financial reforms and service delivery and legal reforms and service delivery influence service delivery in the Kenya Police Service to a great extent. The findings conclude that personnel reforms have a positive and significant influence on service delivery in the Kenya Police Service at Machakos County Police Headquarters in Kenya. The conclusion on financial reforms and Service delivery, legal reforms and service delivery and financial reforms and service delivery have a positive and significant influence on service delivery in the Kenya Police Service. The findings recommend that the Kenya Police Service at Machakos County Police Headquarters should implement the personnel reforms. The findings also recommend that the police service should give police access to improved salary, savings Sacco and increased allowances. The findings furthermore recommend that legal reforms be instated that will assist in conducting impartial investigations, inspections, audits and monitoring of the National Police Service to enhance professionalism and discipline of the Service.

Privatization and intermunicipal cooperation in US local government services: balancing fiscal stress, need and political interests

ABSTRACT The 2007–2008 Global Financial Crisis renewed interest in New Public Management tools. Privatization and intermunicipal cooperation are the two most common forms of service delivery reforms among US local governments. Which is more responsive to fiscal stress, service needs and political interests? Our national survey of 2,109 US local governments in 2017 finds cooperation is more responsive to fiscal stress and community need, while privatization is more common in communities with higher home values. Unionization is associated with more privatization and less cooperation. US local governments balance fiscal stress and community need. Cooperation is the preferred service delivery alternative.

The effects of enhanced primary healthcare interventions on primary care providers\u2019 job satisfaction

BackgroundIn response to the rising burden of cardiovascular risk factors, the Malaysian government has implemented Enhanced Primary Healthcare (EnPHC) interventions in July 2017 at public clinic level to improve management and clinical outcomes of type 2 diabetes and hypertensive patients. Healthcare providers (HCPs) play crucial roles in healthcare service delivery and health system reform can influence HCPs’ job satisfaction. However, studies evaluating HCPs’ job satisfaction following primary care transformation remain scarce in low- and middle-income countries. This study aims to evaluate the effects of EnPHC interventions on HCPs’ job satisfaction.MethodsThis is a quasi-experimental study conducted in 20 intervention and 20 matched control clinics. We surveyed all HCPs who were directly involved in patient management. A self-administered questionnaire which included six questions on job satisfaction were assessed on a scale of 1–4 at baseline (April and May 2017) and post-intervention phase (March and April 2019). Unadjusted intervention effect was calculated based on absolute differences in mean scores between intervention and control groups after implementation. Difference-in-differences analysis was used in the multivariable linear regression model and adjusted for providers and clinics characteristics to detect changes in job satisfaction following EnPHC interventions. A negative estimate indicates relative decrease in job satisfaction in the intervention group compared with control group.ResultsA total of 1042 and 1215 HCPs responded at baseline and post-intervention respectively. At post-intervention, the intervention group reported higher level of stress with adjusted differences of − 0.139 (95% CI -0.266,-0.012; p = 0.032). Nurses, being the largest workforce in public clinics were the only group experiencing dissatisfaction at post-intervention. In subgroup analysis, nurses from intervention group experienced increase in work stress following EnPHC interventions with adjusted differences of − 0.223 (95% CI -0.419,-0.026; p = 0.026). Additionally, the same group were less likely to perceive their profession as well-respected at post-intervention (β = − 0.175; 95% CI -0.331,-0.019; p = 0.027).ConclusionsOur findings suggest that EnPHC interventions had resulted in some untoward effect on HCPs’ job satisfaction. Job dissatisfaction can have detrimental effects on the organisation and healthcare system. Therefore, provider experience and well-being should be considered before introducing healthcare delivery reforms to avoid overburdening of HCPs.

Politicians, bureaucrats and the public–private choice in public service delivery: anybody there pushing for remunicipalization?

ABSTRACT Empirical evidence on remunicipalization remains scarce, and even more so as regards potential differences in the roles played by politicians and bureaucrats in service delivery reform. We use information obtained from a survey of Spanish municipalities to investigate differences in the service delivery preferences of politicians and technical staff, as well as differences in their respective propensities to reform. The results we obtain suggest that bureaucrats have both a stronger preference for private participation in service delivery and for reforming services than do politicians.

Developing the Participatory Capacity of South African Citizens in Municipal Service Delivery through Social Innovation

South Africa’s National Development Plan (NDP) 2030 highlights that an active citizenry is fundamental to the country’s development trajectory. The assumption is that the environment in the country is characterised by social cohesiveness, but the reality is that the service delivery interface between South Africa’s municipalities and citizens is characterised by discontent and a lack of confidence. A sustainable solution is called for that can restore and strengthen this interface while protecting democracy, and this article argues that it can be done through the use of social innovation (SI) by developing the capacity of South African citizens to participate in municipal service delivery. Social innovation underpins processes (collaborations, networks, co-productions) that are undertaken by societal actors, for instance citizens, to find innovative solutions to address societal challenges. South African municipalities’ apparent failure to make adequate use of SI, and citizens’ failure to participate fully during each stage of the service delivery cycle appear to be shortcomings that hamper service delivery reform in the local government sphere. In part, these shortcomings are inherent in the selective participation of citizens in some service delivery stages, which is determined by municipalities. The article argues that the use of SI in service delivery is fundamental to enhancing citizens’ participatory capacity, which in turn could contribute towards strengthening the interface between citizens and municipalities and empowering citizens to influence the governance of municipal services.

Driving performance in the public sector: what can we learn from Malaysia’s service delivery reform?

Purpose The purpose of this paper is to investigate the extent to which Malaysia’s most recent public service reform has improved service delivery and governmental performance. It also endeavors to identify critical success factors that explain reform performance and draw lessons based on the Malaysian experience. Design/methodology/approach The paper adopts a case study approach and draws on data from both primary and secondary sources. Besides a thorough review of official documents and existing literature, the author conducted 20 individual interviews with key informants representing government officials, academics and civil society organizations. Findings The study shows that despite some pitfalls and misgivings, the Government Transformation Program (GTP) has produced concrete improvements in service delivery areas where previous reforms failed. One of the factors that underpin GTP’s relative success is the detailed performance management framework, which helped foster inter-agency collaboration and enforce accountability for results at various levels. Practical implications The GTP success highlights the significance of adapting reform content to local situations especially when reforms are based on external models; sanctions from the highest political office; a dedicated unit to drive the implementation and an effective performance management framework through which individuals and agencies would be held to account for results achieved. Originality/value Despite many and varied reform initiatives attempted in the past, cases of successful reform are rare, especially in developing countries. Little is known on what makes a reform work, a gap exacerbated by notable absence of systematic research on this topic. The paper contributes to address this by reviewing Malaysia’s innovative approach to reform and the insights that the Malaysian experience offers.