Between July and December 2018, RESYST and CHEPSAA (Collaboration for Health Policy and Systems Analysis in Africa) collaborated to produce three, open access health policy and systems teaching case studies.

The writing process was funded by RESYST and two of the case studies draw on RESYST’s research in the area of health systems governance. The case studies were designed to complement two of CHEPSAA’s open access master’s-level courses - Introduction to Complex Health Systems and Health Policy and Policy Analysis– and contain not only the case narratives, but also suggestions for how they could be used in assignments and exams.

Case study 1: The marketing of alcoholic drinks in South Africa

Covering the period March 2011 to May 2017, this case study explores the process through which the 2013 draft Control of Marketing of Alcoholic Beverages Bill was formulated.

This case study’s focus on policy formulation makes it quite distinctive, as it is more common for policy change case studies to cover implementation. The case study can be used to support students to analyse the typical steps in policy formulation, as well as the context of policy change and the support or opposition of different actors; the nature of policy content and how it relates to the interests, values and understandings of actors; and strategies that policy proponents and opponents use to influence the outcome of the policy process.

Case study 2: Health system decentralisation in Kenya

This case study focuses on the early stages (2013-2015) of the decentralisation of government functions that occurred after the adoption of Kenya’s 2010 constitution, in particular how these changes affected the local-level health system and service delivery to communities.

• The case study is useful for stimulating students’ thinking about:
• The influence of the broader political system on the health system;
• The role of time and timing in health system change;
• The (changing) relationships between actors and the software and hardware of the organisational contexts within which reforms come to life;
• The sometimes counter-intuitive impacts of reforms; and
• The impact that changes in one aspect of the broader government or health system can have on other aspects of that same system.

Case study 3: Routine governance in Mitchells Plain sub-district in South Africa

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.