The decentralised drug-resistant TB programme in South Africa: From policy to implementation
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Date
2022
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
University of the Western Cape
Abstract
South Africa is one of the high burden countries for drug-resistant tuberculosis (DR-TB) globally. A
policy supporting decentralised DR-TB treatment provision was introduced in 2011 but to date
implementation has been suboptimal with variable coverage and quality. This thesis opens the ‘black
box’ explaining sub-national policy implementation of DR-TB decentralisation in two provinces of
South Africa, Western Cape and KwaZulu-Natal. The thesis is grounded in the field of policy analysis
and adopts the methodological approach of a qualitative multiple case study, comparing 15 embedded
district and subdistrict cases in the two provinces, through data collected in 94 in-depth interviews,
document reviews, and observations. Applying Walt and Gilson’s Policy Analysis Triangle framework,
the case studies of DR-TB in the two provinces revealed how aspects of actors’ engagement with the
policy instrument, influenced by organisational dynamics and the wider context, resulted in varying
effectiveness of policy implementation.
Description
Philosophiae Doctor - PhD
Keywords
Tuberculosis, Public health, Health system, South Africa