Value of Ethnography: Understanding Health System Financial Management


Financial management is a core health system function. There has been a focus on financing but we are still failing to account for the realities, the “how” and “why” of our weak financial systems. In South Africa, the universal health coverage scheme, National Health Insurance, attempts to re-orient the country’s finances and bridge the divide of 13% of the population spending 86% on private health care. In theory, a re-oriented health care system is the ideal, but in practice if the current public health care system cannot effectively and efficiently manage existing resources, how will the system manage any additional resources? To delve deeper into daily practices at the lowest level of the South Africa health system (the district level, implementation level), I had to make use of a study design which would help yield the necessary information—a qualitative case-study design approach using (1) in-depth interviews and (2) ethnography including participant and nonparticipant observation. Overall, I found that using ethnographic approaches helped with meeting doctoral study objectives and that overall it is an invaluable research technique. The approach assists with identifying further participants for inclusion in the research, collecting more comprehensive data, as well as allowing for knowledge sharing. Practical tips are offered to adequately prepare you if you are considering using ethnography and to help deal with arising challenges. In this case, beyond financial management by using ethnographic approaches, I was able to shed light on teamwork and leadership. In conclusion, the approach re-affirms the contribution of ethnography in seeking out the realities and strengthening data collected.

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