Leadership and governance of community health worker programmes at scale: a cross case analysis of provincial implementation in South Africa

Background National community health worker (CHW) programmes are returning to favour as an integral part of primary health care systems, often on the back of pre-existing community based initiatives. There are significant challenges to the integration and support of such programmes, and they require coordination and stewardship at all levels of the health system. This paper explores the leadership and governance tasks of large-scale CHW programmes at sub-national level, through the case of national reforms to South Africa’s community based sector, referred to as the Ward Based Outreach Team (WBOT) strategy. Methods A cross case analysis of leadership and governance roles, drawing on three case studies of adoption and implementation of the WBOTs strategy at provincial level (Western Cape, North West and Gauteng) was conducted. The primary case studies mapped system components and assessed implementation processes and contexts. They involved teams of researchers and over 200 interviews with stakeholders from senior to frontline, document reviews and analyses of routine data. The secondary, cross case analysis specifically focused on the issues and challenges facing, and strategies adopted by provincial and district policy makers and managers, as they engaged with the new national mandate. From this key sub-national leadership and governance roles were formulated. Results Four key roles are identified and discussed:Negotiating a fit between national mandates and provincial and district histories and strategies of community based servicesDefining new organisational and accountability relationships between CHWs, local health services, communities and NGOsRevising and developing new aligned and integrated planning, human resource, financing and information systemsLeading change by building new collective visions, mobilising political, including budgetary, support and designing implementation strategies. Conclusions This analysis, from real-life systems, adds to understanding of the processes involved in developing CHW programmes at scale, and specifically the negotiated and multilevel nature of leadership and governance in such programmes, spanning analytic, managerial, technical and political roles. Ausführliche Beschreibung

Gespeichert in:

Autor*in:	Schneider, Helen [verfasserIn] Nxumalo, Nonhlanhla

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2017

Schlagwörter:	Community systems Community health workers Community health system strengthening National CHW programmes Governance Leadership Stewardship Strategic management

Anmerkung:	© The Author(s). 2017

Übergeordnetes Werk:	Enthalten in: International journal for equity in health - London : BioMed Central, 2002, 16(2017), 1 vom: 15. Sept.
Übergeordnetes Werk:	volume:16 ; year:2017 ; number:1 ; day:15 ; month:09

Links:	Volltext

DOI / URN:	10.1186/s12939-017-0565-3

Katalog-ID:	SPR028712803

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allfields	10.1186/s12939-017-0565-3 doi (DE-627)SPR028712803 (SPR)s12939-017-0565-3-e DE-627 ger DE-627 rakwb eng Schneider, Helen verfasserin aut Leadership and governance of community health worker programmes at scale: a cross case analysis of provincial implementation in South Africa 2017 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2017 Background National community health worker (CHW) programmes are returning to favour as an integral part of primary health care systems, often on the back of pre-existing community based initiatives. There are significant challenges to the integration and support of such programmes, and they require coordination and stewardship at all levels of the health system. This paper explores the leadership and governance tasks of large-scale CHW programmes at sub-national level, through the case of national reforms to South Africa’s community based sector, referred to as the Ward Based Outreach Team (WBOT) strategy. Methods A cross case analysis of leadership and governance roles, drawing on three case studies of adoption and implementation of the WBOTs strategy at provincial level (Western Cape, North West and Gauteng) was conducted. The primary case studies mapped system components and assessed implementation processes and contexts. They involved teams of researchers and over 200 interviews with stakeholders from senior to frontline, document reviews and analyses of routine data. The secondary, cross case analysis specifically focused on the issues and challenges facing, and strategies adopted by provincial and district policy makers and managers, as they engaged with the new national mandate. From this key sub-national leadership and governance roles were formulated. Results Four key roles are identified and discussed:Negotiating a fit between national mandates and provincial and district histories and strategies of community based servicesDefining new organisational and accountability relationships between CHWs, local health services, communities and NGOsRevising and developing new aligned and integrated planning, human resource, financing and information systemsLeading change by building new collective visions, mobilising political, including budgetary, support and designing implementation strategies. Conclusions This analysis, from real-life systems, adds to understanding of the processes involved in developing CHW programmes at scale, and specifically the negotiated and multilevel nature of leadership and governance in such programmes, spanning analytic, managerial, technical and political roles. Community systems (dpeaa)DE-He213 Community health workers (dpeaa)DE-He213 Community health system strengthening (dpeaa)DE-He213 National CHW programmes (dpeaa)DE-He213 Governance (dpeaa)DE-He213 Leadership (dpeaa)DE-He213 Stewardship (dpeaa)DE-He213 Strategic management (dpeaa)DE-He213 Nxumalo, Nonhlanhla aut Enthalten in International journal for equity in health London : BioMed Central, 2002 16(2017), 1 vom: 15. Sept. (DE-627)356253716 (DE-600)2092056-8 1475-9276 nnns volume:16 year:2017 number:1 day:15 month:09 https://dx.doi.org/10.1186/s12939-017-0565-3 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_375 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4367 GBV_ILN_4700 AR 16 2017 1 15 09
spelling	10.1186/s12939-017-0565-3 doi (DE-627)SPR028712803 (SPR)s12939-017-0565-3-e DE-627 ger DE-627 rakwb eng Schneider, Helen verfasserin aut Leadership and governance of community health worker programmes at scale: a cross case analysis of provincial implementation in South Africa 2017 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2017 Background National community health worker (CHW) programmes are returning to favour as an integral part of primary health care systems, often on the back of pre-existing community based initiatives. There are significant challenges to the integration and support of such programmes, and they require coordination and stewardship at all levels of the health system. This paper explores the leadership and governance tasks of large-scale CHW programmes at sub-national level, through the case of national reforms to South Africa’s community based sector, referred to as the Ward Based Outreach Team (WBOT) strategy. Methods A cross case analysis of leadership and governance roles, drawing on three case studies of adoption and implementation of the WBOTs strategy at provincial level (Western Cape, North West and Gauteng) was conducted. The primary case studies mapped system components and assessed implementation processes and contexts. They involved teams of researchers and over 200 interviews with stakeholders from senior to frontline, document reviews and analyses of routine data. The secondary, cross case analysis specifically focused on the issues and challenges facing, and strategies adopted by provincial and district policy makers and managers, as they engaged with the new national mandate. From this key sub-national leadership and governance roles were formulated. Results Four key roles are identified and discussed:Negotiating a fit between national mandates and provincial and district histories and strategies of community based servicesDefining new organisational and accountability relationships between CHWs, local health services, communities and NGOsRevising and developing new aligned and integrated planning, human resource, financing and information systemsLeading change by building new collective visions, mobilising political, including budgetary, support and designing implementation strategies. Conclusions This analysis, from real-life systems, adds to understanding of the processes involved in developing CHW programmes at scale, and specifically the negotiated and multilevel nature of leadership and governance in such programmes, spanning analytic, managerial, technical and political roles. Community systems (dpeaa)DE-He213 Community health workers (dpeaa)DE-He213 Community health system strengthening (dpeaa)DE-He213 National CHW programmes (dpeaa)DE-He213 Governance (dpeaa)DE-He213 Leadership (dpeaa)DE-He213 Stewardship (dpeaa)DE-He213 Strategic management (dpeaa)DE-He213 Nxumalo, Nonhlanhla aut Enthalten in International journal for equity in health London : BioMed Central, 2002 16(2017), 1 vom: 15. Sept. (DE-627)356253716 (DE-600)2092056-8 1475-9276 nnns volume:16 year:2017 number:1 day:15 month:09 https://dx.doi.org/10.1186/s12939-017-0565-3 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_375 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4367 GBV_ILN_4700 AR 16 2017 1 15 09
allfields_unstemmed	10.1186/s12939-017-0565-3 doi (DE-627)SPR028712803 (SPR)s12939-017-0565-3-e DE-627 ger DE-627 rakwb eng Schneider, Helen verfasserin aut Leadership and governance of community health worker programmes at scale: a cross case analysis of provincial implementation in South Africa 2017 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2017 Background National community health worker (CHW) programmes are returning to favour as an integral part of primary health care systems, often on the back of pre-existing community based initiatives. There are significant challenges to the integration and support of such programmes, and they require coordination and stewardship at all levels of the health system. This paper explores the leadership and governance tasks of large-scale CHW programmes at sub-national level, through the case of national reforms to South Africa’s community based sector, referred to as the Ward Based Outreach Team (WBOT) strategy. Methods A cross case analysis of leadership and governance roles, drawing on three case studies of adoption and implementation of the WBOTs strategy at provincial level (Western Cape, North West and Gauteng) was conducted. The primary case studies mapped system components and assessed implementation processes and contexts. They involved teams of researchers and over 200 interviews with stakeholders from senior to frontline, document reviews and analyses of routine data. The secondary, cross case analysis specifically focused on the issues and challenges facing, and strategies adopted by provincial and district policy makers and managers, as they engaged with the new national mandate. From this key sub-national leadership and governance roles were formulated. Results Four key roles are identified and discussed:Negotiating a fit between national mandates and provincial and district histories and strategies of community based servicesDefining new organisational and accountability relationships between CHWs, local health services, communities and NGOsRevising and developing new aligned and integrated planning, human resource, financing and information systemsLeading change by building new collective visions, mobilising political, including budgetary, support and designing implementation strategies. Conclusions This analysis, from real-life systems, adds to understanding of the processes involved in developing CHW programmes at scale, and specifically the negotiated and multilevel nature of leadership and governance in such programmes, spanning analytic, managerial, technical and political roles. Community systems (dpeaa)DE-He213 Community health workers (dpeaa)DE-He213 Community health system strengthening (dpeaa)DE-He213 National CHW programmes (dpeaa)DE-He213 Governance (dpeaa)DE-He213 Leadership (dpeaa)DE-He213 Stewardship (dpeaa)DE-He213 Strategic management (dpeaa)DE-He213 Nxumalo, Nonhlanhla aut Enthalten in International journal for equity in health London : BioMed Central, 2002 16(2017), 1 vom: 15. Sept. (DE-627)356253716 (DE-600)2092056-8 1475-9276 nnns volume:16 year:2017 number:1 day:15 month:09 https://dx.doi.org/10.1186/s12939-017-0565-3 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_375 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4367 GBV_ILN_4700 AR 16 2017 1 15 09
allfieldsGer	10.1186/s12939-017-0565-3 doi (DE-627)SPR028712803 (SPR)s12939-017-0565-3-e DE-627 ger DE-627 rakwb eng Schneider, Helen verfasserin aut Leadership and governance of community health worker programmes at scale: a cross case analysis of provincial implementation in South Africa 2017 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2017 Background National community health worker (CHW) programmes are returning to favour as an integral part of primary health care systems, often on the back of pre-existing community based initiatives. There are significant challenges to the integration and support of such programmes, and they require coordination and stewardship at all levels of the health system. This paper explores the leadership and governance tasks of large-scale CHW programmes at sub-national level, through the case of national reforms to South Africa’s community based sector, referred to as the Ward Based Outreach Team (WBOT) strategy. Methods A cross case analysis of leadership and governance roles, drawing on three case studies of adoption and implementation of the WBOTs strategy at provincial level (Western Cape, North West and Gauteng) was conducted. The primary case studies mapped system components and assessed implementation processes and contexts. They involved teams of researchers and over 200 interviews with stakeholders from senior to frontline, document reviews and analyses of routine data. The secondary, cross case analysis specifically focused on the issues and challenges facing, and strategies adopted by provincial and district policy makers and managers, as they engaged with the new national mandate. From this key sub-national leadership and governance roles were formulated. Results Four key roles are identified and discussed:Negotiating a fit between national mandates and provincial and district histories and strategies of community based servicesDefining new organisational and accountability relationships between CHWs, local health services, communities and NGOsRevising and developing new aligned and integrated planning, human resource, financing and information systemsLeading change by building new collective visions, mobilising political, including budgetary, support and designing implementation strategies. Conclusions This analysis, from real-life systems, adds to understanding of the processes involved in developing CHW programmes at scale, and specifically the negotiated and multilevel nature of leadership and governance in such programmes, spanning analytic, managerial, technical and political roles. Community systems (dpeaa)DE-He213 Community health workers (dpeaa)DE-He213 Community health system strengthening (dpeaa)DE-He213 National CHW programmes (dpeaa)DE-He213 Governance (dpeaa)DE-He213 Leadership (dpeaa)DE-He213 Stewardship (dpeaa)DE-He213 Strategic management (dpeaa)DE-He213 Nxumalo, Nonhlanhla aut Enthalten in International journal for equity in health London : BioMed Central, 2002 16(2017), 1 vom: 15. Sept. (DE-627)356253716 (DE-600)2092056-8 1475-9276 nnns volume:16 year:2017 number:1 day:15 month:09 https://dx.doi.org/10.1186/s12939-017-0565-3 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_375 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4367 GBV_ILN_4700 AR 16 2017 1 15 09
allfieldsSound	10.1186/s12939-017-0565-3 doi (DE-627)SPR028712803 (SPR)s12939-017-0565-3-e DE-627 ger DE-627 rakwb eng Schneider, Helen verfasserin aut Leadership and governance of community health worker programmes at scale: a cross case analysis of provincial implementation in South Africa 2017 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2017 Background National community health worker (CHW) programmes are returning to favour as an integral part of primary health care systems, often on the back of pre-existing community based initiatives. There are significant challenges to the integration and support of such programmes, and they require coordination and stewardship at all levels of the health system. This paper explores the leadership and governance tasks of large-scale CHW programmes at sub-national level, through the case of national reforms to South Africa’s community based sector, referred to as the Ward Based Outreach Team (WBOT) strategy. Methods A cross case analysis of leadership and governance roles, drawing on three case studies of adoption and implementation of the WBOTs strategy at provincial level (Western Cape, North West and Gauteng) was conducted. The primary case studies mapped system components and assessed implementation processes and contexts. They involved teams of researchers and over 200 interviews with stakeholders from senior to frontline, document reviews and analyses of routine data. The secondary, cross case analysis specifically focused on the issues and challenges facing, and strategies adopted by provincial and district policy makers and managers, as they engaged with the new national mandate. From this key sub-national leadership and governance roles were formulated. Results Four key roles are identified and discussed:Negotiating a fit between national mandates and provincial and district histories and strategies of community based servicesDefining new organisational and accountability relationships between CHWs, local health services, communities and NGOsRevising and developing new aligned and integrated planning, human resource, financing and information systemsLeading change by building new collective visions, mobilising political, including budgetary, support and designing implementation strategies. Conclusions This analysis, from real-life systems, adds to understanding of the processes involved in developing CHW programmes at scale, and specifically the negotiated and multilevel nature of leadership and governance in such programmes, spanning analytic, managerial, technical and political roles. Community systems (dpeaa)DE-He213 Community health workers (dpeaa)DE-He213 Community health system strengthening (dpeaa)DE-He213 National CHW programmes (dpeaa)DE-He213 Governance (dpeaa)DE-He213 Leadership (dpeaa)DE-He213 Stewardship (dpeaa)DE-He213 Strategic management (dpeaa)DE-He213 Nxumalo, Nonhlanhla aut Enthalten in International journal for equity in health London : BioMed Central, 2002 16(2017), 1 vom: 15. Sept. (DE-627)356253716 (DE-600)2092056-8 1475-9276 nnns volume:16 year:2017 number:1 day:15 month:09 https://dx.doi.org/10.1186/s12939-017-0565-3 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_375 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4367 GBV_ILN_4700 AR 16 2017 1 15 09
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The secondary, cross case analysis specifically focused on the issues and challenges facing, and strategies adopted by provincial and district policy makers and managers, as they engaged with the new national mandate. From this key sub-national leadership and governance roles were formulated. Results Four key roles are identified and discussed:Negotiating a fit between national mandates and provincial and district histories and strategies of community based servicesDefining new organisational and accountability relationships between CHWs, local health services, communities and NGOsRevising and developing new aligned and integrated planning, human resource, financing and information systemsLeading change by building new collective visions, mobilising political, including budgetary, support and designing implementation strategies. 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author	Schneider, Helen
spellingShingle	Schneider, Helen misc Community systems misc Community health workers misc Community health system strengthening misc National CHW programmes misc Governance misc Leadership misc Stewardship misc Strategic management Leadership and governance of community health worker programmes at scale: a cross case analysis of provincial implementation in South Africa
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topic_title	Leadership and governance of community health worker programmes at scale: a cross case analysis of provincial implementation in South Africa Community systems (dpeaa)DE-He213 Community health workers (dpeaa)DE-He213 Community health system strengthening (dpeaa)DE-He213 National CHW programmes (dpeaa)DE-He213 Governance (dpeaa)DE-He213 Leadership (dpeaa)DE-He213 Stewardship (dpeaa)DE-He213 Strategic management (dpeaa)DE-He213
topic	misc Community systems misc Community health workers misc Community health system strengthening misc National CHW programmes misc Governance misc Leadership misc Stewardship misc Strategic management
topic_unstemmed	misc Community systems misc Community health workers misc Community health system strengthening misc National CHW programmes misc Governance misc Leadership misc Stewardship misc Strategic management
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title	Leadership and governance of community health worker programmes at scale: a cross case analysis of provincial implementation in South Africa
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title_full	Leadership and governance of community health worker programmes at scale: a cross case analysis of provincial implementation in South Africa
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title_sort	leadership and governance of community health worker programmes at scale: a cross case analysis of provincial implementation in south africa
title_auth	Leadership and governance of community health worker programmes at scale: a cross case analysis of provincial implementation in South Africa
abstract	Background National community health worker (CHW) programmes are returning to favour as an integral part of primary health care systems, often on the back of pre-existing community based initiatives. There are significant challenges to the integration and support of such programmes, and they require coordination and stewardship at all levels of the health system. This paper explores the leadership and governance tasks of large-scale CHW programmes at sub-national level, through the case of national reforms to South Africa’s community based sector, referred to as the Ward Based Outreach Team (WBOT) strategy. Methods A cross case analysis of leadership and governance roles, drawing on three case studies of adoption and implementation of the WBOTs strategy at provincial level (Western Cape, North West and Gauteng) was conducted. The primary case studies mapped system components and assessed implementation processes and contexts. They involved teams of researchers and over 200 interviews with stakeholders from senior to frontline, document reviews and analyses of routine data. The secondary, cross case analysis specifically focused on the issues and challenges facing, and strategies adopted by provincial and district policy makers and managers, as they engaged with the new national mandate. From this key sub-national leadership and governance roles were formulated. Results Four key roles are identified and discussed:Negotiating a fit between national mandates and provincial and district histories and strategies of community based servicesDefining new organisational and accountability relationships between CHWs, local health services, communities and NGOsRevising and developing new aligned and integrated planning, human resource, financing and information systemsLeading change by building new collective visions, mobilising political, including budgetary, support and designing implementation strategies. Conclusions This analysis, from real-life systems, adds to understanding of the processes involved in developing CHW programmes at scale, and specifically the negotiated and multilevel nature of leadership and governance in such programmes, spanning analytic, managerial, technical and political roles. © The Author(s). 2017
abstractGer	Background National community health worker (CHW) programmes are returning to favour as an integral part of primary health care systems, often on the back of pre-existing community based initiatives. There are significant challenges to the integration and support of such programmes, and they require coordination and stewardship at all levels of the health system. This paper explores the leadership and governance tasks of large-scale CHW programmes at sub-national level, through the case of national reforms to South Africa’s community based sector, referred to as the Ward Based Outreach Team (WBOT) strategy. Methods A cross case analysis of leadership and governance roles, drawing on three case studies of adoption and implementation of the WBOTs strategy at provincial level (Western Cape, North West and Gauteng) was conducted. The primary case studies mapped system components and assessed implementation processes and contexts. They involved teams of researchers and over 200 interviews with stakeholders from senior to frontline, document reviews and analyses of routine data. The secondary, cross case analysis specifically focused on the issues and challenges facing, and strategies adopted by provincial and district policy makers and managers, as they engaged with the new national mandate. From this key sub-national leadership and governance roles were formulated. Results Four key roles are identified and discussed:Negotiating a fit between national mandates and provincial and district histories and strategies of community based servicesDefining new organisational and accountability relationships between CHWs, local health services, communities and NGOsRevising and developing new aligned and integrated planning, human resource, financing and information systemsLeading change by building new collective visions, mobilising political, including budgetary, support and designing implementation strategies. Conclusions This analysis, from real-life systems, adds to understanding of the processes involved in developing CHW programmes at scale, and specifically the negotiated and multilevel nature of leadership and governance in such programmes, spanning analytic, managerial, technical and political roles. © The Author(s). 2017
abstract_unstemmed	Background National community health worker (CHW) programmes are returning to favour as an integral part of primary health care systems, often on the back of pre-existing community based initiatives. There are significant challenges to the integration and support of such programmes, and they require coordination and stewardship at all levels of the health system. This paper explores the leadership and governance tasks of large-scale CHW programmes at sub-national level, through the case of national reforms to South Africa’s community based sector, referred to as the Ward Based Outreach Team (WBOT) strategy. Methods A cross case analysis of leadership and governance roles, drawing on three case studies of adoption and implementation of the WBOTs strategy at provincial level (Western Cape, North West and Gauteng) was conducted. The primary case studies mapped system components and assessed implementation processes and contexts. They involved teams of researchers and over 200 interviews with stakeholders from senior to frontline, document reviews and analyses of routine data. The secondary, cross case analysis specifically focused on the issues and challenges facing, and strategies adopted by provincial and district policy makers and managers, as they engaged with the new national mandate. From this key sub-national leadership and governance roles were formulated. Results Four key roles are identified and discussed:Negotiating a fit between national mandates and provincial and district histories and strategies of community based servicesDefining new organisational and accountability relationships between CHWs, local health services, communities and NGOsRevising and developing new aligned and integrated planning, human resource, financing and information systemsLeading change by building new collective visions, mobilising political, including budgetary, support and designing implementation strategies. Conclusions This analysis, from real-life systems, adds to understanding of the processes involved in developing CHW programmes at scale, and specifically the negotiated and multilevel nature of leadership and governance in such programmes, spanning analytic, managerial, technical and political roles. © The Author(s). 2017
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title_short	Leadership and governance of community health worker programmes at scale: a cross case analysis of provincial implementation in South Africa
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The secondary, cross case analysis specifically focused on the issues and challenges facing, and strategies adopted by provincial and district policy makers and managers, as they engaged with the new national mandate. From this key sub-national leadership and governance roles were formulated. Results Four key roles are identified and discussed:Negotiating a fit between national mandates and provincial and district histories and strategies of community based servicesDefining new organisational and accountability relationships between CHWs, local health services, communities and NGOsRevising and developing new aligned and integrated planning, human resource, financing and information systemsLeading change by building new collective visions, mobilising political, including budgetary, support and designing implementation strategies. 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Leadership and governance of community health worker programmes at scale: a cross case analysis of provincial implementation in South Africa

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