‘We had to manage what we had on hand, in whatever way we could’: Adaptive responses in policy for decentralized drug-resistant tuberculosis care in South Africa

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Date

2021

Journal Title

Journal ISSN

Volume Title

Publisher

Oxford University Press

Abstract

In 2011, the South African National TB Programme launched a policy of decentralized management of drug-resistant tuberculosis (DR-TB) in order to expand the capacity of facilities to treat patients with DR-TB, minimize delays to access care and improve patient outcomes. This policy directive was implemented to varying degrees within a rapidly evolving diagnostic and treatment landscape for DR-TB, placing new demands on already-stressed health systems. The variable readiness of district-level systems to implement the policy prompted questions not only about differences in health systems resources but also front-line actors’ capacity to implement change in resourceconstrained facilities.

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Keywords

Policy implementation, Decentralization, Tuberculosis, Health systems, Public health, South Africa

Citation

Kielmann, K. et al. (2021). ‘We had to manage what we had on hand, in whatever way we could’: Adaptive responses in policy for decentralized drug-resistant tuberculosis care in South Africa. Health Policy and Planning, 36(3), 249 - 259. 10.1093/heapol/czaa147