Tshwane managers identify continuous support for quality-of-care regulations

Healthcare managers working in public health facilities across Tshwane Municipality, South Africa, described capacity building as a continuous, multi-level support system for implementing the country’s Norms and Standards Regulations and improving quality of care. Their accounts, collected through interviews with 12 managers, identified four interconnected themes: structured, role-responsive learning; integration of learning within quality-improvement and implementation systems; stronger professional and information practices; and contextual conditions shaping the effectiveness of capacity-building efforts.

The findings come from a descriptive phenomenological study conducted as part of a broader project intended to develop a framework for implementing the regulations. Researchers conducted face-to-face and virtual semi-structured interviews with 12 purposively selected healthcare managers from public health facilities in Tshwane, Gauteng Province. They analysed the interview data using Colaizzi’s seven-step phenomenological method. The study examines the perspectives of managers involved in implementation; it does not measure the effects of a capacity-building intervention, compare facilities, or assess changes in patient outcomes.

Participants emphasised both formal and workplace-based training tailored to managers’ roles. They also identified feedback from audits, supportive leadership, customer care, professional ethics, documentation competence and digital readiness as important dimensions of implementation support. Rather than treating training as a stand-alone event, the managers described learning that is connected to the systems used in everyday clinical and administrative work. Audit feedback, ongoing professional development and stronger documentation and information practices were seen as ways of translating regulatory requirements into routine action. Across the interviews, the central message was that sustained, coordinated support is needed at several organisational levels if managers are to implement the standards consistently.

The study also highlights structural limits on what managers can achieve through capacity-building activities. Staffing shortages and system-level resource constraints were perceived by participants as restricting their ability, and that of their teams, to meet regulatory requirements consistently. These conditions mean that an additional course or information session may not be sufficient on its own: the effectiveness of implementation support is also shaped by the availability of staff, resources and functioning systems. The findings describe managers’ accounts of those conditions rather than providing a quantitative estimate of their effect on compliance or care quality.

Overall, the research identifies capacity building as a strategic mechanism for strengthening healthcare managers’ ability to implement the Norms and Standards Regulations. The authors conclude that implementation-support strategies should extend beyond once-off training to include continuous, role-responsive learning, supportive leadership, audit-informed improvement, professional development, stronger documentation and digital readiness. Because the evidence comes from 12 purposively selected managers in one municipal area, the results are locally grounded and should not be treated as a system-wide evaluation of regulatory compliance. They nevertheless provide a basis for developing an implementation framework in Tshwane and can inform work in comparable South African public health settings, where the study suggests such support may contribute to safer, more consistent and quality-assured care.

Subject of Research: Healthcare managers’ perspectives on capacity building for implementing public health regulations in Tshwane, South Africa

Article Title: Capacity building for quality of care: healthcare managers’ perspectives on Norms and Standards Regulations in Tshwane public health facilities, South Africa

Article References: Matahela, S. R., Matahela, V. E., Adekola, A. P., & Mavhandu-Mudzusi, A. H. (2026). Capacity building for quality of care: healthcare managers’ perspectives on Norms and Standards Regulations in Tshwane public health facilities, South Africa. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15631-7

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15631-7

Keywords: capacity building, quality of care, healthcare management, public health facilities, Tshwane, South Africa, health regulations, audit feedback, professional development, digital readiness, Capacity, building