Addressing Structural Inhibitors of Change in Public Health Sector Organizations: A South African Case

This article draws attention to the structural inhibitors of effective service delivery within a South African public health organization and outlines a new initiative that aims to facilitate the decentralization of decision-making power in an attempt to transform the service offered by this organization. The intervention outlined utilizes a participatory action research (PAR) methodology. As the problem addressed by this intervention is a political one, a social constructionist theoretical framework was adopted. The article reports on a current intervention that, if successful, will bring significant change to a public health service and will highlight the role of political factors in the inhibition or facilitation of change in public health services. It draws attention to the political and structural factors that undermine the capacity of a public health service to manage a range of communicable diseases, especially new drug-resistant variants of TB. This phenomenon is a growing global problem and the article outlines an innovative initiative that is attempting to address it. It is still too early to comment on the political success of the PAR initiative regarding the decentralization of powers within this service. However, the intervention has already created strong morale capital (resources such as courage, commitment and resilience) in district teams that were previously demoralized. The analysis of the situation is based upon the author's experience of this service over a period of 10 years.