Exploring the nature of governance at the level of implementation for health system strengthening: the DIALHS experience

This article presents a South African case study of an intervention to address conflict in roles and responsibilities between multiple actors supporting service delivery at the local level. The study shows how, through action learning and reflection, local managers in two organizations came to understand how the higher level misalignment of organizational structures and processes imposed governance constraints on them. By re-framing the conflict as organizational, they were then able to create opportunities for staff to understand their context and participate in negotiating principles for communication and collaborative work. The result reduced conflict between staff in the two organizations, leading to improved implementation of programme support.

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Scott V, Schaay N, Olckers P, Nqana N, Lehmann U, Gilson L. Exploring the nature of governance at the level of implementation for health system strengthening: the DIALHS experience. Health Policy and Planning. 2014;29(suppl 2):ii59-ii70. doi:10.1093/heapol/czu073