‘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.
Description
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