Experiences of nurses regarding the implementation of an ideal clinic project in eThekwini district, KwaZulu-Natal

Abstract

Introduction and background: The key outcome of the vision of the government of South Africa is the attainment of a long and healthy life for all of its citizens. In view of this, the government of South Africa has embarked on a phased implementation of the National Health Insurance (NHI) scheme in order to achieve universal health coverage so that there is access to appropriate, affordable efficient quality health care services for all. The South African National Department of Health introduced the ideal clinic realisation and maintenance programme in response to the current shortages of primary health care (PHC) services and to lay a strong foundation for the implementation of NHI. The programme includes an algorithmic approach to change all the PHC clinics to adhere to the NHI standards. An ideal clinic is defined as a clinic with good infrastructure, adequate staff, adequate medicine and supplies, good administrative processes, and sufficient adequate bulk supplies. Nevertheless, reports indicated that the target of achieving the 50% mark in selected vital areas such as staffing, resource allocation and utilisation, by 2019, has not been achieved. Aim and objectives of the study: The aim of the study was to explore and describe the experiences of nurses regarding the implementation of an ideal clinic project in eThekwini district, KwaZulu-Natal. The objectives of the study were to: explore and describe the experiences of nurses regarding the implementation of an ideal clinic project; determine the perception of nurses regarding the implementation of an ideal clinic project, describe the support, if any, received by the nurses during the implementation of the ideal clinic project; determine the challenges if any experienced by nurses during the implementation of an ideal clinic, and to determine the strategies that can be instituted to facilitate successful implementation of an ideal clinic project. Method: A qualitative research design which using an explorative and descriptive approaches was employed with Donabedian’s structure, process and outcome model used as a theoretical framework to guide the study. Data were collected through one-on-one semi-structured interviews with the nurses who were involved in the implementation of ideal clinic projects in the 18 PHC clinics under Prince Mshiyeni Memorial Hospital between the 16th September 2020 and the 26th October 2020. Findings: The six major themes that emerged from the interviews included structural limitations, processes involved in the running of the clinic, support offered to the PHC clinics, communications and staff involvements, staff training and administration of an ideal clinic project all of which interfered with successful implementation of this project. Conclusion: The findings of the study confirmed that the nurses who are the drivers of this ideal clinic project have many negative experiences and perceptions which make it difficult to fulfil the ideal clinic project standards. It was evident from the study that there was little support offered to them when it came to ideal clinic implementation. However, the study also revealed that there are a number of actions that could be instituted in order to bring the ideal clinic status to fruition such as improvement of infrastructure, training of staff and addition of more staff and instituting staff involvement in the ideal clinic project as a whole. Recommendations: Recommendations are made in relation to policy formulation and implementation, service delivery, nursing education and research. The recommendations made from this study were based on the strategies that can be instituted to improve the ideal clinic implementation. The recommendations were made with special reference to the employment of more trained staff, improvement of infrastructure of the facilities, staff involvement in the implementation of any programmes and adequate support of staff members regarding the implementation of the ideal clinic project.