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 patients need them.
The Affordable Medicines Directorate (AMD) of the NDoH has multiple projects and interventions that provide solutions and implementation capabilities to the nine provinces, including leading a broad initiative to increase supply chain capability via its visibility and analytics network (VAN). There are different but interlinked projects underway, driven by various technical assistance partners.
The gap between what had been designed and the actual return on investment realised from these initiatives prompted the NDoH to seek support from the Africa Resource Centre (ARC) to identify the gaps affecting implementation 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. The NDoH presented this need to donors in 2018.
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 the status of several projects. Some projects had been underway for several years but were either not implemented successfully, or consultants still ran them 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 common approach to engaging the intended audience for interventions early in their development. Additional interventions included setting up a change tracking routine to monitor the adoption of new systems and processes. ARC also introduced targeted training investments to aid change management capacity development within the provinces.
ARC then developed a comprehensive process to facilitate change management in line with the project plans for the various initiatives underway. ARC formulated an approach to communicate and drive the adoption of a supply chain transformation roadmap at national, provincial and public health facility levels. The aim was to develop change management capacity and skills and to create a platform for a multi-year, integrated change management programme for the health supply chain. The approach was to advise the NDoH on a change management strategy and formulate plans for a comprehensive approach to communicate and drive adoption of change at the national, provincial, district and facility levels.
As part of this work, ARC developed an integrated workbook outlining the change management process. This workbook encapsulates the change management methodology developed for the NDoH in a practical manner, including an extensive catalogue of assessments done throughout a project to understand whether it is on track and gaining positive momentum.
ARC also worked to coordinate, advise and support provincial change management subject matter experts on change management best practices, tools and techniques to enable sustainable adoption of the AMD SIMA and VAN programmes.
In 2020, the team comprised one senior Change Management Lead and additional dedicated resources, each for KwaZulu-Natal and Gauteng. Due to funding constraints, ARC reduced the team to only the Change Management Lead at the end of May 2021.
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. ARC realigned and refocused its work to develop and conduct regular coaching and mentoring sessions to facilitate the transition into these new working conditions for pharmaceutical staff while building resilience capability and cultivating their understanding of the change cycle. 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 begin, ARC has been working with the NDoH on its approach to COVID-19 vaccine rollouts and has 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 element: improvement roadmap and solutions proposals
The NDoH had identified a need to refine the implementation of its supply chain and healthcare initiatives. ARC stepped up to develop a change management framework that understands that the ‘people’ element is as crucial as the technical considerations to strengthen health supply chain systems. 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 effects of change on their motivation and ability to implement new approaches.
DEVELOPING A CHANGE MANAGEMENT STRATEGY
Key element: strategy
Having a clear strategy for people development through change management ensures long-term buy-in from many different stakeholders that are key for successfully implementing new supply chain initiatives. ARC developed a change management strategy, framework, methodology and workbook.
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 element: 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. It included a communications strategy that leveraged tools like roadshows and internal AMD newsletters.
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.