As part of its work to deliver increasingly effective healthcare in South Africa, the National Department of Health (NDoH) has undertaken several public health supply chain strengthening initiatives in recent years. Through collaboration with implementing partners responsible for the design, development, and implementation of these initiatives, the NDoH has increasingly found innovative ways to ensure that medicines and health products are available when and where they are needed across the country. However, in many cases, there is a gap between what is designed and the actual return on investment realised from these initiatives. As a result, the NDoH sought support from the Africa Resource Centre (ARC) to identify the gaps affecting the implementation of these initiatives and provide a solution to address them.
In its assessment, ARC identified the need for a comprehensive change management strategy to bridge the gap between design, implementation, and adoption in many of the NDoH’s healthcare initiatives. Change management is an essential but often overlooked component of new systems and approaches. People’s innate responses to change need to be intentionally acknowledged and addressed before they can apply the behaviour change required to adopt a new way of working or deliver a new initiative. If people do not change in a sustainable manner, the intended benefit of the change will not materialise. In 2019, ARC completed an in-depth review of the NDoH’s current projects to assess each project’s health. The results highlighted challenges in several projects, some of which had been underway for several years but were either not implemented successfully or in which consultants still performed work due to a lack of change management. In other cases, projects were closed without the knowledge, capability, sign off or adoption of the NDoH and provincial health departments. ARC developed a comprehensive process to facilitate change management in line with the project plans for the various initiatives that were underway. As part of this work, an integrated workbook outlining the change management process was developed. This workbook encapsulates the change management methodology developed for the NDoH in a practical manner, including an extensive catalogue of assessments that are done throughout a project to understand whether it is on track and gaining positive momentum.
ADAPTING FOR COVID-19
With the change management process established, ARC had begun working within the provincial health departments’ governance structures to carry out its proposed change management measures. However, when the COVID-19 pandemic started, the focus shifted away from change initiatives to addressing the public health demands accelerated by the pandemic.
ARC identified an opportunity to apply its change management methodology to assist healthcare workers in coping with the seismic change in their work demands and working environments because of the pandemic.
Healthcare workers, including pharmaceutical staff, were under severe stress and emotional distress due to the rapidly changing demands and working situations they faced and the natural fear of exposing their families to COVID-19 because of their work.
To facilitate the transition into these new working conditions for pharmaceutical staff while building resilience capability and cultivating their understanding of the change cycle, ARC realigned and refocused its work to develop and conduct regular coaching and mentoring sessions. These sessions helped equip and empower the healthcare workers to understand their responses to the changes, deal with each stage to keep the momentum going in their work, and lead their teams through the different stages while staying motivated.
Additionally, as vaccine distribution efforts began, ARC worked with the NDoH on its approach to COVID-19 vaccine rollouts and developed a change methodology to support its vaccine project.
OUTCOMES AND IMPACT
ARC’s support to ministries of health focuses on strengthening six supply chain elements. The work on change management with the NDoH strengthened four of these six areas: strategy, improvement roadmap, policies and research, and solutions proposals.
IMPROVING THE RETURN ON INVESTMENT OF SUPPLY CHAIN INITIATIVES
Key elements: improvement roadmap and solutions proposals
The NDoH had identified a need to refine the implementation of its supply chain and healthcare initiatives, and ARC stepped up to develop a change management framework that understands that to strengthen health supply chain systems, the
‘people’ element is as crucial as the technical considerations. This change management framework provides a roadmap for future implementation while also providing a solution to increase the effectiveness of existing initiatives.
IMPACT: Key stakeholders across the supply chain have the tools to understand and address the impact of change on their motivation and ability to implement new approaches.
DEVELOPING A CHANGE MANAGEMENT STRATEGY
Key elements: strategy
Having a clear strategy for people development through change management ensures long-term buy-in from many different stakeholders that are key to successfully implementing new supply chain initiatives.
IMPACT: The change management workbook can be applied to existing and future projects to garner buy-in from affected stakeholders at all levels of the supply chain.
CREATING PEOPLE-CENTRIC APPROACHES
Key elements: Policies and research
The change management methodology developed by ARC for the NDoH was a structured, scientific solution that reflects an understanding of the significant role people at all levels of a supply chain project play in its implementation and success.
IMPACT: The NDoH was able to respond to COVID-19 and support healthcare workers with change management skills that helped them during the pandemic and which they can apply to future changes in their work environment.