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Using implementation science to address quadruple burden of disease in SA

07 November 2024 | Story André Damons | Photo Supplied

Implementation Science Workshop 2024 — Building capacity for the use of implementation science. The Principal Investigators of the project; Dr Phindile Shangase from UFS, left, and Dr Lebogang Mogongoa from the Central University of Technology, with Dr Shalini Ahuja from King’s College London, centre, who facilitated the workshops.

The Division of Public Health at the University of the Free State (UFS) together with the Central University of Technology (CUT), held a successful workshop (first phase) for their project: Capacity building for the use of implementation science in various typologies in low- and middle-income countries for the prevention and/or management of the quadruple burden of disease.

According to the National Institute for Health as well as the World Health Organisation, implementation science supports innovative approaches to identifying, understanding, and overcoming barriers to the adoption, adaptation, integration, scale-up and sustainability of evidence-based interventions, tools, policies, and guidelines. Implementation research therefore pertains to gathering and analysing implementation evidence of effectiveness that determines if the intervention works in real-world circumstances.

The Principal Investigator at UFS is Dr Phindile Shangase from the Division of Public Health, supported by colleagues in the Division, as well as the CUT team, led by Dr Lebogang Mogongoa. The first phase of the project took place from 14-17 October 2024 with the first two days held at UFS.

In this co-funded project, UFS and CUT engage in partnership capacity building for academics and postgraduate students. At the UFS, the project is funded by the Office of the Deputy Vice-Chancellor: Research and Internationalisation and resulted from the CUT and UFS Joint Research Programme Research Grant 9th Call.

Contributing to evidence-based policies and practices

Dr Shangase says the workshops of this project were well attended by academics, researchers, postgraduate and postdoctoral students from different disciplines, and community organisations, including programme managers, as well as clinicians from the Department of Health. Other stakeholders and international students who could not travel for face-to-face interactions attended live on UFS YouTube.

Workshops were facilitated by Dr Shalini Ahuja from King’s College, London, who is an international expert and experienced in this field through engaging in research as well as field facilitation in various low- and middle-income countries.

Says Dr Shangase: “Implementation science is the study of methods and strategies to promote the systematic uptake of research findings. It contributes to evidence-based policies and practices and ensures that they are implemented effectively to achieve their intended outcomes, through the identification of barriers and facilitators to implementation. These strategies can therefore be integrated effectively into routine practice in healthcare, public health, and other fields.

“Reviewed studies indicate that the effectiveness of implementation research is noted in the identification and investigation of factors that address disparities in healthcare delivery and outcomes, including those within the health systems and in the population. In simple terms, the goal of implementation science is to understand how and why some interventions succeed while others fail, and to identify the best ways to integrate research-backed interventions into real-world settings for maximum impact and to ensure they continue to be used and remain effective over time,” says Dr Shangase.

Purpose of project

According to her, in the context of South Africa, implementation science has potential to assist in addressing the quadruple burden of disease which comprise of these colliding epidemics: maternal, newborn and child health; HIV/AIDS and tuberculosis (TB); non-communicable diseases (e.g. cardiovascular diseases, chronic respiratory diseases, cancers, and diabetes); and violence and injury.

The purpose of this project, explains Dr Shangase, is to capacitate academics and postgraduate students at the UFS and CUT as well as community stakeholders with knowledge and skills regarding the processes and factors involved in the successful integration of evidence-based public health improvement interventions into routine practice and policy.

“Implementation science offers a strategic, data-driven approach for South Africa, especially in addressing the country’s unique and complex healthcare challenges. These advantages stem from its focus on translating evidence-based interventions into real-world practice, addressing the quadruple burden of disease and helping overcome systemic obstacles to effective healthcare delivery.

“These advantages make implementation science a vital tool for improving health outcomes and achieving sustainable public health progress in South Africa.”

The next phase of this project is expected to be more innovative and takes place between February and March in 2025 with the inclusion of a multistakeholder team.

News Archive

"Service" needs to return to public service

2010-09-14

At the memorial lecture were, from the left, front: Chris Hendriks, Proff. Liezel Lues, Chris Thornhill and Lyndon du Plessis; middle: Prof. Hendri Kroukamp, Mss Alet Fouche, Lizette Pretorius; and back: Proff. Koos Bekker and Moses Sindane.
– Photo: Stephen Collett.

There is a serious need for the concept of “service” to be reintroduced to the public service. In addition to this, public servants need to behave ethically and honestly if the public service were to achieve its main aim of service delivery to South African citizens and thereby also restore the trust of citizens in the state.

This was the central theme of the JN Boshoff Commemorative Lecture hosted by the Department of Public Administration and Management at the University of the Free State UFS). The lecture by Prof. Chris Thornhill, emeritus professor of Public Administration and Management at the University of Pretoria, focused on “Administrative and Governmental Challenges: Lessons from the Past”. He drew pertinent parallels with the administrative and governmental practices during the times of Pres. JN Boshoff, second president of the Orange Free State in 1855, and the challenges faced in this regard by the current government and public service.

Prof. Thornhill highlighted important aspects such as globalisation, the environment, public service and democratic government in his presentation.
He said the borders between countries have all but vanished and governments therefore have to carefully consider the effects of globalisation on its domestic affairs. The strength of a country’s currency, for example, was not only determined by how that country viewed or perceived it, but also by the international community’s perception of that country’s political and economic stability. This, in turn, could have serious implications for that country’s investment and economic prospects.

Governments are compelled to attend to the utilisation of its natural resources as these resources are finite and therefore irreplaceable. Policy interventions have to be introduced to decrease or regulate the use of certain natural resources or alternative measures need to be introduced. The example of bio-fuel production in various countries was highlighted.

He said the South African public service is characterised by three debilitating factors, namely the prevalence of corruption, the interference of politicians in administrative functions and a lack of appropriate skills and therefore a lack of commitment on the part of officials. In the municipal sector, for example, 46% of municipal managers have less than one year’s experience and this mainly occurs because of the practice of deployment (the appointment of a person based on political affiliation). An amendment to the Local Government: Municipal Systems Act is currently under consideration, in terms of which municipal managers will be disallowed to hold party political positions simultaneously.

According to Prof. Thornhill this is a step in the right direction, but more needs to be done to neutralise the impact of these debilitating factors in order to restore the credibility of the public service.

On democratic government Prof. Thornhill said the fact that the majority of a country’s citizens elect a political party to power does not automatically make the government capable of governing effectively and efficiently. It is therefore important for the rulers to understand their governing role within a democratic context, but more importantly to act accordingly. It is also important not to centralise power unduly as this could be a serious threat to accountable government. The 17th amendment to the Constitution, 1996, currently under consideration, and in terms of which national and provincial government will be allowed to intervene in local government matters, was highlighted as a case in point.

Prof. Thornhill said it was essential for those involved to sincerely and honestly and ethically deal with the above matters for the public service to overcome current challenges.

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