Barriers, Enablers, and Cost Implications of Scaling the AURUM Management Development Programme (MDP): District Manager Reflections from the Western Cape
1
Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
2
Department of Work and Social Psychology, Maastricht University, Maastricht, Netherlands
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Strong management capacity is essential for effective primary healthcare (PHC). The AURUM Management Development Programme (MDP) was implemented to strengthen primary healthcare and district-level leadership in the Western Cape province of South Africa. This study identifies contextual barriers, enabling conditions, and cost implications associated with the program’s broader scalability.
METHODS:
This study employed a qualitative design, informed by programme cost data, to investigate the barriers, enablers, and cost implications associated with scaling the MDP. Qualitative: In-depth interviews with purposively selected district health managers from three Western Cape districts were audio-recorded, transcribed, and thematically analysed using NVivo 14. Programme cost information from a companion economic analysis was used to contextualise managers’ reflections on affordability and scalability, without undertaking formal comparative or quantitative economic analysis.
RESULTS:
Twenty participants (7 males, 13 females) from the Cape Winelands, Garden Route, and Cape Town Metro districts' health offices were interviewed. The MDP was viewed as relevant, practical, and adaptable, with district readiness for MDP implementation emerging as a common marker of perceived success. High readiness for MDP implementation was characterised by clear team roles, strong team structures, decentralised decision-making, digital tool use, ongoing mentorship structures, and clinics that had prior exposure to PHC reforms (e.g., Ideal Clinic Realisation and Maintenance (ICRM) program). Low readiness was marked by staff shortages, limited district-level leadership support for implementation, and partially functional health systems. Key enablers of the MDP implementation included integration with existing training units that are already operating in the health system, visible service improvements, and active leadership engagement by district management, demonstrated through committed managerial support.
CONCLUSIONS:
The MDP shows potential for scalability, contingent on district readiness for implementation, leadership support, district-level leadership support, integration into existing training platforms, and sustained follow-up.
Strong management capacity is essential for effective primary healthcare (PHC). The AURUM Management Development Programme (MDP) was implemented to strengthen primary healthcare and district-level leadership in the Western Cape province of South Africa. This study identifies contextual barriers, enabling conditions, and cost implications associated with the program’s broader scalability.
METHODS:
This study employed a qualitative design, informed by programme cost data, to investigate the barriers, enablers, and cost implications associated with scaling the MDP. Qualitative: In-depth interviews with purposively selected district health managers from three Western Cape districts were audio-recorded, transcribed, and thematically analysed using NVivo 14. Programme cost information from a companion economic analysis was used to contextualise managers’ reflections on affordability and scalability, without undertaking formal comparative or quantitative economic analysis.
RESULTS:
Twenty participants (7 males, 13 females) from the Cape Winelands, Garden Route, and Cape Town Metro districts' health offices were interviewed. The MDP was viewed as relevant, practical, and adaptable, with district readiness for MDP implementation emerging as a common marker of perceived success. High readiness for MDP implementation was characterised by clear team roles, strong team structures, decentralised decision-making, digital tool use, ongoing mentorship structures, and clinics that had prior exposure to PHC reforms (e.g., Ideal Clinic Realisation and Maintenance (ICRM) program). Low readiness was marked by staff shortages, limited district-level leadership support for implementation, and partially functional health systems. Key enablers of the MDP implementation included integration with existing training units that are already operating in the health system, visible service improvements, and active leadership engagement by district management, demonstrated through committed managerial support.
CONCLUSIONS:
The MDP shows potential for scalability, contingent on district readiness for implementation, leadership support, district-level leadership support, integration into existing training platforms, and sustained follow-up.
| eISSN: | 2654-1459 |
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