Scaling up integration: Development and results of a participatory assessment of HIV/TB services, South Africa

dc.contributor.authorScott, Vera
dc.contributor.authorChopra, Mickey
dc.contributor.authorAzevedo, Virginia
dc.contributor.authorCaldwell, Judy
dc.contributor.authorNaidoo, Pren
dc.contributor.authorSmuts, Brenda
dc.date.accessioned2010-11-24T14:29:04Z
dc.date.available2010-11-24T14:29:04Z
dc.date.issued2010
dc.description.abstractBACKGROUND: In 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. METHODS: A 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. RESULTS: 16 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. CONCLUSIONS: This 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.en_US
dc.identifier.citationScott V., et al. (2010). Scaling up integration: Development and results of a participatory assessment of HIV/TB services, South Africa. Health Research Policy and Systems, 8:23.en_US
dc.identifier.urihttp://hdl.handle.net/10566/173
dc.language.isoenen_US
dc.privacy.showsubmitterfalse
dc.publisherBioMed Central Ltden_US
dc.rights© 2010 Scott et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
dc.source.urihttp://dx.doi.org/10.1186/1478-4505-8-23
dc.status.ispeerreviewedtrue
dc.subjectProgramme evaluationen_US
dc.subjectHIV/AIDSen_US
dc.subjectTuberculosisen_US
dc.subjectSexually transmitted infections (STIs)en_US
dc.subjectIntegrationen_US
dc.subjectSouth Africaen_US
dc.subjectHealthcareen_US
dc.titleScaling up integration: Development and results of a participatory assessment of HIV/TB services, South Africaen_US
dc.typeArticleen_US

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