title: Health system reform in peri-urban communities: an exploratory study of policy strategies towards healthcare worker reform in Epworth, Zimbabwe.
abstract: BACKGROUND
  Human resources for health (HRH) remains a critical challenge, according to the Kampala Declaration and Agenda for Global Action of 2008 and the 2030 Sustainable Development Agenda. Available literature on health system reforms does not provide a detailed narrative on strategies that have been used to reform HRH challenges in peri-urban communities. This study explores such strategies implemented in Epworth, Zimbabwe, during 2009-2014, and the implications these strategies might have on other peri-urban areas.
  
  
  METHODS
  Qualitative and quantitative methods were used in an exploratory and cross-sectional design. Purposive sampling was used to select key informants, a sample of healthcare workers that participated in in-depth interviews and community members who took part in focus group discussions. Secondary data were collected through a documentary search. Qualitative data were analysed through thematic analysis. Quantitative secondary data were examined using descriptive statistics and then compared with qualitative data to reinforce analysis.
  
  
  RESULTS
  The HRH reform policy strategies that were identified included ministerial intervention; policy review; and revival of the human resource for health planning, financial planning, multi-sector collaboration, and community engagement. These had some positive effects; however, desired outcomes were undermined by financial, material, human resource, and social constraints.
  
  
  CONCLUSIONS
  Despite constraints, the strategies helped revive the health delivery system in Epworth. In turn, this had a favourable outlook on post-2008 efforts by the Global Health Alliance towards healthcare worker reform and the 2030 Sustainable Development Agenda in peri-urban communities.
authors.affiliation: School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa; htaderera@gmail.com.
authors.forename: Bernard Hope
authors.initials: BH
authors.lastname: Taderera
authors.affiliation: School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa.
authors.forename: Stephen James Heinrich
authors.initials: SJ
authors.lastname: Hendricks
authors.affiliation: National Department of Health of the Republic of South Africa, Pretoria, South Africa.
authors.forename: Yogan
authors.initials: Y
authors.lastname: Pillay
keywords: health; peri-urban; reform; strategies; worker