BACKGROUND

The overall project goal of the project is to increase access and availability of safe and effective treatment of

HIV and AIDS in the uninsured population (disadvantaged communities) of South Africa. The strategy to

achieve this goal focuses on Human Capacity Development through activities that are designed to

strengthen the AIDS leadership and HR management at the district (delivery) level to deal with all aspects

of improved AIDS service delivery.

To date efforts to develop AIDS management and leadership in South Africa has focused on providing

training which is an obvious first step to developing managerial competencies however not all managers are

able to attend such training while others often are not aware of the fact that they do not have the required

skills to effectively undertake their managerial tasks. This is understandable given that there has never been

a culture of requiring management qualifications from health care managers in South Africa leading in effect

to a system of amateur managers. The default health care manager in South Africa is a health care

professional who has migrated into management (95% of AIDS managers surveyed in the University of

Pretoria study referred to earlier met this profile).

This project is designed to supplement existing management training efforts, by various role players

including PEPFAR partners that focus on providing management qualifications, and to create an alternative

management development method that will develop management competencies of managers who cannot

enroll for formal academic qualifications. This project will also establish, at the district level continues

professional development structures that will serve all managers from the district be they from government

or civil society with or with out management qualifications.

The project will engage in the following specific activities:

• Provide professional support services to qualified AIDS managers: the project will on an annual basis

enroll 500 managers at a district level form both the public sector and civil society who have formal

management qualification, and therefore qualify as SAIHCM members as members for a one year period.

This will introduce them to a series of services customized to support the professional development of

health care managers. These include: 1) a monthly health management journal; 2) access to the SAIHCM

mentorship program; 3) an annual management conference and 4) regular newsletters via e-mail on health

management issues and ethical issues 5) the annual top 25 health care leaders award (see annexure B for

examples of these products). As part of this component, SAIHCM will do a survey to build a database of

qualified health care managers in the country. It is anticipated that once managers have experienced the

benefits of these services they or their employer will take over the payment of membership fees in the

following years.

• Assess the training and development needs of AIDS managers: On annual basis to engage 500 managers

who have not received formal management training and managers who received such training a long time

ago in fifty Development Centre Events (DCE). This is an internally focused activity where the individual

manager takes stock of his / her own learning styles, preferences, strengths, weaknesses and development

needs. These events are a sophisticated means of identifying and developing competencies which

individuals and teams require taking on new roles effectively. It provides an in-depth picture of an individual

by gathering data form many sources during a three-day intensive event conducted by a skilled facilitator.

The end result is that the management development needs of each participating health care managers is

identified and converted in a personal development strategy that will include enrolling in formal courses, self

study, selected reading and participating in peer learning events called Action Learning Sets (ALS).

• Establish in each district a forum for leadership development for AIDS managers. To establish 50 Action

Learning Sets per annum at the level of the health district. These are structured facilitated learning events,

taking place every two months, that managers attend. These sessions, of one-day duration, entail a

continuous process of learning and reflection with the intention of collectively developing solutions to

tangible problems. Learning is centered on the need to find solutions to a real problems faced by the

managers in implementing AIDS projects. Learning is voluntary and learner driven, while individual

development is as important as finding the solution to the problem. Action Learning is an approach to

management development pioneered by Reg Revans . It is based on his premise that "there can be no

learning without action and no sober and deliberate action without learning. Revans described learning as

having two elements: namely traditional instruction and critical reflection or questioning insight. He

maintained that learning equals programmed learning plus questioning insights. The Action Learning Set

(ALS) is designed to support predominantly the critical reflection component of learning. ALS's are learning

group comprising 10-20 members including a facilitator. The set will meet one day every 6-8 weeks.

Attendance and commitment creates a culture of mutual support and challenge. Groups normally have a

facilitator whose main responsibility is helping the group create a culture that is supportive and challenging.

SAIHCM will further provide ALS members with access to a mentor, who will be an AIDS manager that has

a formal management qualification and who has received a complimentary SAIHCM membership on the

basis of their willingness to fulfill this role. The supervision by a SAIHCM facilitator will only be required for

the first six-month period. Once the ALS structures have been established they continue under an elected

group leader as forums for continuous professional development, peer support, mechanism to improve

morale and forums where collaboration between managers from both the public and the private sector can

be promoted. SAIHCM will continuously monitor that the ALS remain active and actively support group

leaders to ensure continuation. SAIHCM will on a two monthly basis interact with group leaders via a

dedicated web based discussion forum and newsletter. The purpose of this interaction is to provide group

leaders with subject matter for the bi-monthly meetings and share the hot topics for discussion identified by

other districts. Annually group leaders will convene at the SAIHCM Conference. Articles produced by or

relevant to the ALS's will be published in the SAIHCM Journal to further share lessons learned with the

broader health management community.

Implementation of this project will rely on developing partnerships with various role players at the district

level involved in AIDS service delivery and capacity development.

• Training institutions: SAIHCM already has a close working relationship with the FPD a private institution of

higher education, and a PEPFAR training partner. In this context SAIHCM provides alumni of PFD

management training programs access to SAIHCM membership benefits. This relationship will be leveraged

Activity Narrative: to create a conduit to channel managers into sponsored formal clinical and managerial training courses

offered by FPD. SAIHCM will also actively engage other PEPFAR partners who offer training, using the

PEPFAR training catalogue with the same objective. Any AIDS manager who is a graduate from a formal

training program such as those offered by FPD, will also be invited to attend the ALS's as a channel for

them to engage in life-long learning.

• PEPFAR Partners and Civil Society AIDS Service organizations: SAIHCM will also at the district level

engage PEPFAR partners and other AIDS service organizations form civil society to invite their managers to

participate in the project. An added benefit of involving civil society leaders and managers is that it will

create a forum where the district level leaders from both the public and the private sector will interact

leading hopefully to increased public-private-partnerships.

• Provincial Government: SAIHCM will work in partnerships with the Human Resources Departments of the

Provincial Departments of Health in the all provinces to develop the capacity of AIDS managers at the

district level based on the outcomes of the DCE's and ALS's. The District Health Services competency

framework, described below, will be used to assess managers during DCE's is one that was introduced in

the pilot phase with full support of Provincial and National Health Department management. The Health

Systems Framework will guide the project. All interventions will be aligned developing the competencies to

implement this framework.