ArticleBMJ global health2022
The role of emergent champions in policy implementation for decentralised drug-resistant tuberculosis care in South Africa.
Article in BMJ global health, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Building capacity for change: developing an evidence-based competencies framework to power champions.BMJ quality & safety · 2026Article
- Bridging the Gap Between Treatment and Accountability: DR-TB Outcomes and Governance Signals in Rural Eastern Cape, South Africa (2020-2024).Infectious disease reports · 2026Article
- Implementing collaborative practices in healthcare settings using champions: a scoping review.Implementation science : IS · 2025Article
- How policy entrepreneurs solve local health problems in the global South: an exploratory study.Health policy and planning · 2025Article
- The effects of decentralisation on patient and service outcomes: a case of the 2018 decentralisation of multidrug-resistant tuberculosis in Zambia.Archives of public health = Archives belges de sante publique · 2025Article
- Actor sensemaking and its role in implementation of the decentralized drug-resistant tuberculosis policy in South Africa.Health policy and planning · 2025Article
- Strengthening accountability for tuberculosis policy implementation in South Africa: perspectives from policymakers, civil society, and communities.BMC global and public health · 2024Article
- Opinion review of drug resistant tuberculosis in West Africa: tackling the challenges for effective control.Frontiers in public health · 2024Review
- Organisation of care for people receiving drug-resistant tuberculosis treatment in South Africa: a mixed methods study.BMJ open · 2023Article
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Authors and funding
12 authors.
Funding
Abstract
objectiveChampions are recognised as important to driving organisational change in healthcare quality improvement initiatives in high-income settings. In low-income and middle-income countries with a high disease burden and constrained human resources, their role is highly relevant yet understudied. Within a broader study on policy implementation for decentralised drug-resistant tuberculosis care in South Africa, we characterised the role, strategies and organisational context of emergent policy champions.
designInterviews with 34 healthcare workers in three South African provinces identified the presence of individuals who had a strong influence on driving policy implementation forward. Additional interviews were conducted with 13 participants who were either identified as champions in phase II or were healthcare workers in facilities in which the champions operated. Thematic analyses using a socio-ecological framework further explored their strategies and the factors enabling or obstructing their agency.
resultsAll champions occupied senior managerial posts and were accorded legitimacy and authority by their communities. 'Disease-centred' champions had a high level of clinical expertise and placed emphasis on clinical governance and clinical outcomes, while 'patient-centred' champions promoted pathways of care that would optimise patients' recovery while minimising disruption in other spheres of their lives. Both types of champions displayed high levels of resourcefulness and flexibility to adapt strategies to the resource-constrained organisational context.
conclusionPolicymakers can learn from champions' experiences regarding barriers and enablers to implementation to adapt policy. Research is needed to understand what factors can promote the sustainability of champion-led policy implementation, and to explore best management practices to support their initiatives.
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