Abstract
BackgroundIn South Africa the need to integrate HIV, TB and STI programmes has been recognised at a policy and organisation level; the challenge is now one of translating policies into relevant actions and monitoring implementation to ensure that the anticipated benefits of integration are achieved. In this research, set in public primary care services in Cape Town, South Africa, we set out to determine how middle level managers could be empowered to monitor the implementation of an effective, integrated HIV/TB/STI service.MethodsA team of managers and researchers designed an evaluation tool to measure implementation of key components of an integrated HIV/TB/STI package with a focus on integration. They used a comprehensive health systems framework based on conditions for programme effectiveness and then identified and collected tracer indicators. The tool was extensively piloted in two rounds involving 49 clinics in 2003 and 2004 to identify data necessary for effective facility-level management. A subsequent evaluation of 16 clinics (2 per health sub district, 12% of all public primary care facilities) was done in February 2006.Results16 clinics were reviewed and 635 records sampled. Client access to HIV/TB/STI programmes was limited in that 50% of facilities routinely deferred clients. Whilst the physical infrastructure and staff were available, there was problem with capacity in that there was insufficient staff training (for example, only 40% of clinical staff trained in HIV care). Weaknesses were identified in quality of care (for example, only 57% of HIV clients were staged in accordance with protocols) and continuity of care (for example, only 24% of VCT clients diagnosed with HIV were followed up for medical assessment). Facility and programme managers felt that the evaluation tool generated information that was useful to manage the programmes at facility and district level. On the basis of the results facility managers drew up action plans to address three areas of weakness within their own facility.ConclusionsThis use of the tool which is designed to empower programme and facility managers demonstrates how engaging middle managers is crucial in translating policies into relevant actions.
Highlights
In South Africa the need to integrate HIV, TB and sexually transmitted infections (STIs) programmes has been recognised at a policy and organisation level; the challenge is one of translating policies into relevant actions and monitoring implementation to ensure that the anticipated benefits of integration are achieved
In Cape Town in 2002 a task team was established consisting of district programme managers and academics to address the research question: How can middle level health managers be empowered to monitor the implementation of an effective, integrated HIV/TB/STI service? In this paper we describe the development of a participatory monitoring and evaluation tool which, in the context of the prevailing fragmented HIV, TB and STI programmes, provided a uniform approach to quality assurance across the three programmes and introduced an integration lens within each programme to demonstrate missed opportunities in preventative, early case detection and care activities for the other programmes
They worked in staff teams led by each facility manager to identify the relative strengths and weaknesses of their individual facilities
Summary
In South Africa the need to integrate HIV, TB and STI programmes has been recognised at a policy and organisation level; the challenge is one of translating policies into relevant actions and monitoring implementation to ensure that the anticipated benefits of integration are achieved. One systematic review of integration of vertical programmes concluded that there is no strong evidence of variation in the impact or outcome between vertically provided programmes and integrated ones [11] This seems especially the case in resource-poor settings where there is a risk that resources will be spread so thinly across the different service-delivery activities and the support functions (such as supervision, logistics and training) that activities could fail to reach the minimum quantity and quality for any impact on health. In particular the effect on programme performance at district and facility level is a sensitive indicator of whether the policy is achieving its goal of improving the quality and efficiency of services
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
