Kielmann, KarinaDickson-Hall, LindyJassat, Waasila2022-07-192022-07-192021Kielmann, 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/czaa1471460-223710.1093/heapol/czaa147http://hdl.handle.net/10566/7615In 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.enPolicy implementationDecentralizationTuberculosisHealth systemsPublic healthSouth AfricaArticle