Novel study provides glimpses into clinic managers’ working conditions Private diaries revealed the unsatisfactory working conditions of South African Primary Health Care clinic nursing managers. If not addressed, these concerns can derail necessary and imminent healthcare system reforms. Dr. Pascalia Munyewende is a senior researcher, social scientist and science communication expert at the University of the Witwatersrand, Johannesburg. Orcid ID: 0000-0002-1244-8799 Further information: https://doi.org/10.3402/gha.v7.25323
A collage of colourful diary pages with handwritten notes, sketches, and photos of health care workers and patients in different settings. Presented in association with the University of the Witwatersrand, Johannesburg, this programme forms part of #theArtofResearch, an initiative of research communication specialists Jive Media Africa. The support of the Carnegie Corporation for the Carnegie Diversifying the Academy (CTDA) program at the University of the Witwatersrand, South Africa, towards this science communication output is hereby acknowledged. Opinions expressed and conclusions arrived at, are those of the author and are not to be attributed to the Carnegie Corporation or the CDTA.
“The clinic was full and staff members were not enough. I was juggling the dispensary, [patient] consulting, had to solve patients’ minor queries and attend to my supervisor.” These were the words of a Free Statebased Primary Health Care (PHC) clinic nursing manager, a role crucial to providing PHC services in South Africa and managing the network of more than 3,000 government PHC clinics and community health centres. Yet, researchers at Wits specialising in health policy and systems found a general lack of appreciation of clinic managers as
a critical component of the health workforce. Studies have concentrated on hospitals, rather than on PHC facilities, or nurses rather than clinic managers. However, it is the clinic nursing managers that will play a critical role in coming major health system reforms. My study explored the work experiences of PHC clinic nursing managers using reflective diaries, an innovative method of capturing the lived work experiences of managers at the PHC level. They allow for confidentiality and anonymity, often impossible with other qualitative
research methods. For my study, fifteen nursing managers kept diaries for six weeks with a predefined set of questions. The diaries revealed that PHC clinic nursing managers want a positive working environment for effective service delivery. They want responsive emergency medical services, good referral systems, adequate medicines, human resources, a supportive management environment including budget control, accurate health information systems, leadership and governance and to experience positive emotions in clinics. Problems include shortages of human resources like nurses, pharmacists and cleaners, staff absenteeism and lack of professionalism, unsupportive management, leadership and governance problems and the detrimental emotional impact of clinic management. There is an opportunity for policy makers to address the root causes of health system deficiencies and co-create inclusively for an enabling work environment. Should these concerns not be addressed, demotivated PHC clinic managers could derail health sector reforms because they are unlikely to be able to be the necessary champions for these changes.