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UCT RESEARCH REPORT 2012
Research Projects
Universal Coverage in
Tanzania and South Africa:
Monitoring and Evaluating
Progress (UNITAS)
UNITAS is a five-year research partnership project funded
by the European Commission. Launched in 2011, it is a
collaborative project with partners from UCT’s Health
Economics Unit, the Centre for Health Policy, University
of the Witwatersrand, and the Africa Centre, University
of KwaZulu-Natal (in South Africa), Ifakara Health Institute
(in Tanzania), the London School of Hygiene and Tropical
Medicine, and the Institute of Tropical Medicine Antwerp
(in Belgium).
District Innovation and
Action for Health Systems
Development (DIALHS)
The DIALHS project is an action-learning partnership
between the Provincial Government of the Western Cape,
the City of Cape Town and researchers from the Schools
of Public Health at the universities of Cape Town and the
Western Cape.
The goal of universal health coverage is receiving
increasing international attention. South Africa is
introducing a systemof universal healthcare entitlements
to be funded from general tax and additional dedicated
tax revenue. Tanzania is integrating existing health-
insurance schemes for formal and informal-sector
workers under the management of a single insurer. In
both countries, financing reforms are being supported
by wide-ranging efforts to improve the delivery and
management of health services. Combined, these
reforms intend to reduce existing health-system
inequalities and improve population, health service and
healthcare-cost coverage.
Translating such health financing, service delivery and
management reforms into intended changes ‘on the
ground’ requires a well-functioning monitoring and
evaluation system which provides data that allow policies
to be improved over time, and consequently strengthen
their potential to achieve universal health coverage. While
many questions about the most appropriate design of
universal coverage reforms in different contexts remain,
even less is known about how to implement reform
policies effectively. There is an urgent need to gain
detailed insights into reform implementation processes
to improve the likelihood of successful health-system
reform. The UNITAS project aims to support the
implementation of reforms intended to achieve universal
coverage in South Africa and Tanzania by monitoring and
evaluating the policy processes.
South Africa is introducing a
system of universal healthcare
entitlements.
Initiated in 2010 within the Mitchell’s Plain sub-
district in Cape Town, this collaborative project
applies iterative cycles of learning, reflection and
action, with the aim of better understanding how to
act to support strengthened functioning within the
district and primary healthcare system.
The focus of work to date has centred on issues of
governance and governing, including understanding
the complexity of the sub-district, as well as the
organisational and personal capacities needed to
support primary health care. Identifying the particular
importance of the tangible and intangible software
elements of organisational capacity, the work so far
has focused on the soft skills needed by sub-district
and primary healthcare managers, and mechanisms to
support these managers in their work, the role of formal
and informal (tacit) knowledge in routine healthcare
decision-making processes, the identity-transition
process undergone by primary healthcare nurses
when becoming facility managers, and approaches to
implementing meaningful community participation in
health and health care. While the project has included
some formal data collection elements (largely through
in-depth interviews and facility observations), the key
approach to learning has been through participation.
In distilling lessons, partners have drawn on reflective
practice and theories of change approaches and have
sought to work with colleagues in the system to learn
lessons together.