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

Abstract Background The Norms and Standards Regulations provide a regulatory foundation for safe, quality care in South African public health facilities. Yet implementation remains inconsistent, with persistent non-compliance reported in Tshwane Municipality. Because healthcare managers translate these regulations into routine practice, their capacity is critical. However, limited evidence exists on how managers themselves understand the role of capacity building in supporting implementation. This study explored healthcare managers’ perspectives on capacity building as a strategic mechanism for implementing the Norms and Standards Regulations and improving quality of care. Methods A descriptive phenomenological design was used as part of a broader study aimed at developing a framework to guide the implementation of the Norms and Standards Regulations. Data were collected through face-to-face and virtual semi-structured interviews with 12 purposively selected healthcare managers from public health facilities in Tshwane Municipality, Gauteng Province, South Africa. Data were analysed using Colaizzi’s seven-step phenomenological method. Results One overarching theme and four interrelated themes were generated. Overall, participants described capacity building as a continuous, multi-level support system for implementing the Norms and Standards Regulations and improving quality of care. The themes were: structured and role-responsive learning; integration of learning within quality improvement and implementation support systems; strengthening of professional and information practices; and contextual conditions influencing the effectiveness of capacity-building efforts. Participants emphasised formal and workplace-based training, audit feedback, supportive leadership, customer care, professional ethics, documentation competence and digital readiness. Staffing shortages and system-level resource constraints were perceived to limit effectiveness. Conclusions Healthcare managers in Tshwane Municipality understand capacity building as a continuous, multi-level support system rather than as discrete training events. Capacity building is a strategic mechanism for strengthening managers’ ability to implement the Norms and Standards Regulations and improve quality of care in public health facilities. Implementation support strategies should move beyond once-off training to include continuous, role-responsive learning, supportive leadership, audit-informed improvement, professional development, documentation strengthening and digital readiness. Strengthening these dimensions may also contribute to public health facility preparedness for South Africa’s universal health coverage agenda by supporting safer, more consistent and quality-assured care. These findings inform the development of a framework to guide implementation support for healthcare managers in Tshwane and comparable South African public health settings. Trial registration Not applicable.