Drawing on the experience of the Mitchells Plain sub-district in Cape Town, South Africa, this case study provides a window onto the routine functioning of a local-level health system and the ways in which middle managers and frontline staff have sought to cope with their challenges and do things differently to improve the health system’s functioning.
This case study highlights:
- The structural complexity of health systems, as well as the complex, multi-directional relationships that are required for the system to work;
- The different ways in which a health system can be governed;
- The full range of skills required of mid-level managers and health facility managers;
- The values, mind-sets and relationships of different health system actors; and
- Ways in which managers can strengthen the health system, especially through strategies that are sensitive to power, communication, relationships and values.