Leadership Challenges in a Resource-Constrained Health Care System in South Africa’s North West Province Case Study

These findings, among the first to qualitatively examine leadership challenges within South Africa's district health system, highlight how centralised decision-making, weak performance management, and resource constraints specifically impede service delivery in the North West Province. By offering context-specific insights and practical strategies for decentralisation, governance strengthening, and resource optimisation, this study provides locally relevant evidence to inform health system reform in similar low- and middle-income settings.