A Dissertation submitted to the Faculty of Health Sciences, School of Public Health,
University of the Witwatersrand, to fulfil the requirement to acquire a degree of
Master of Science in Medicine
Johannesburg
30 September 2014 / Background
In South Africa cervical cancer has an age standardised incidence rate of 23 per 100
000 in women below the age of 35 and 76 per 100 000 amongst women over 35.
The National Department of Health (NDoH) introduced the national cervical cancer
screening policy guidelines in 2000, with the aim to screen 70% of women aged
between 30 and 59 over a 10-year period. Health managers at provincial and district
level were expected to implement this policy at their respective levels. Research has
shown that implementing national health policies is often challenging due to
management weaknesses, including the lack of guidelines or tools on how managers
should plan and allocate budget for services.
Aim
The aim of this study is to develop and test an approach to planning and budgeting
that would assist health managers to follow a rational process to plan and estimate
budget requirements for implementing the cervical cancer screening policy at subnational
level.
Method
This study was conducted in three districts in South Africa. The study was conducted
in four phases. A situational analysis of budgeting practices was conducted in the
first phase, to describe existing planning and budget allocation practices for cervical
cancer screening programmes in the study sites and identify any existing gaps. The
process requirements for implementing a cervical cancer screening programme were
then identified prospectively in the second phase. Informed by the situation analysis
and the process requirements, a computer-based planning and budget estimation
program was developed in the third phase and tested through interviews with key
informants in the fourth phase of the study.
Results
The situational analysis revealed a lack of involvement of interviewed programme
managers at all the levels, in planning and budgeting for implementing cervical
cancer screening programmes. The participants’ descriptions of budget allocation
processes indicated that there was no defined process for allocating budget to
services and the allocations were not specifically informed by assessed programme
needs in their respective areas of jurisdiction.
Process requirements for cervical screening were identified and documented for the
following aspects of a cervical screening programme: calculating target population to
inform planning for service provision, staff and equipment audits, equipment and
supplies, material required for systems functioning (e.g., tools, forms, guidelines),
transport and communication systems, community information education and
communication (IEC) strategies, staff training, laboratory services and services for
the treatment of High grade Squamous Intraepithelial Lesions (HSIL). A computerbased
planning and budget estimation program, which could enable managers to
define and quantify resources needed to implement a cervical screening programme
was developed, informed by the documented process requirements.
The testing of the computerised planning and budget estimation program indicated
that the program could improve planning and help managers to estimate budget
requirements for implementing cervical screening. Respondents indicated that the
program was relatively easy to use and also felt that it could potentially be useful for
programme planning as follows: a) it could serve as a tool for programme needs
assessment, b) it could facilitate rational budget estimations, c) managers could use
it as a bottom-up tool to motivate for resources, and d) managers could use it to
refute inadequate budget allocations where possible.
Conclusion
The findings of the situational analysis support existing literature in revealing very
little if any change in relation to inherent challenges in implementing cervical cancer
screening services in South Africa. The findings of this study are relevant for public
health programme planning and budgeting beyond cervical screening. Since
managers at sub-national level are delegated to implement policy, it is imperative
that they are provided with tools that may guide them to plan and budget for services
on the basis of needs in their areas of jurisdiction. This study provides one such
tool.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/17423 |
| Date | 16 April 2015 |
| Creators | Robertson, Jamela Ellen |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf, application/pdf |
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