Towards The Successful Implementation Of Intervention Strategies In Three Namibian State Hospitals: A Deterministic Framework

ABSTRACT

Healthcare reform is a difficult policy issue that involves complex trade-offs between

policy goals, such as ensuring access to high-quality healthcare and keeping public

spending at fiscally affordable levels. Namibia, like most emerging economies faces

challenges in expanding public healthcare coverage without undermining its fiscal

sustainability. Yet, in the wake of the 2008 global financial crisis, developed countries

had to undertake fiscal consolidation, which has seen a decline in the flow of donor funds

to healthcare in developing countries. With dwindling donor funding and increased public

outcry on the deterioration of healthcare delivery systems in Namibia, the Ministry of

Health and Social Services had for the first time since independence, to introduce the

Health Sector Strategic Plan 2009 – 2013. With this in mind, the aim of this study was to

develop a deterministic framework for the successful measurement of healthcare service

quality in public healthcare organisations, focusing on the staff members’ satisfaction

levels with the 2009 - 2013 strategic decisions implementation in three Namibian State

hospitals based in Windhoek (Katutura), Rundu and Oshakati. A quantitative interpretive

structural modelling (ISM) approach was used within an action implementation

framework (AIF). The AIF is an implementation science approach that played the dual

role of providing a hands-on approach to implement strategy and identifying determinants

for its evaluation. As such, this study employed three models that complied with the action

implementation framework’s dual roles. The EIS model provided the hands on support to

the implementing strategy role by retrospectively focusing on the 2009-2013 MoHSS

Strategic plan implementation. While, the Enablers, also referred to as the Implementation

Success Factors (ISF) model and the Inhibitors, also referred to as the Implementation

Failure Factors (IFF) models were used to identify the determinants for its evaluation. The

study used primary data from a cross-sectional field survey of 290 staff from the three

intermediate state hospitals. The study found 13 effective factors related to four

dimensions, which are content of the strategy, contextual, structural, and operational

factors. As such, the study concludes that content and context factors are interdependent

such that the content of the strategy depends on the strategic context. At the same time,

effective implementation depends on the operational factors, which are also influenced by

structural factors during the strategy formulation stage. Consequently, the study

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formulated a research model for the successful measurement of healthcare service quality

in public healthcare organisations based on the perceptions of the healthcare staff. The

study recommends that the intermediate hospitals should have their own financial

management strategies that guide the implementation of national strategies and policies.