Abstract:

Mr. Joseph Nkosi, the Manager of the Lesedi District Health Department, South Africa, was hopeful that he could bring increased resources and better health to the area. Lesedi District, one of about 50 districts in 9 provinces in South Africa, was a largely rural area saddled with high levels of poverty, poor infrastructure, and high mortality rates; medical needs were high but almost half of the positions in the health department were unfilled, and turnover among staff was high. In South Africa, there was a push to improve primary care and to decentralize management to local levels in order to respond to local needs more effectively, but the processes for planning, reporting and budgeting were extremely complex and did not seem to support that goal. Mr. Nkosi wondered what additional skills he needed in order to work the system, and was also thinking about how the system itself could be improved.

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