Uwimana, JeannineJackson, DebraHausler, HarryZarowsky, Christina2012-11-012012-11-012012Uwimana, J., et al. (2012). Health system barriers to implementation of collaborative TB and HIV activities including prevention of mother to child transmission in South Africa. Tropical Medicine and International Health, 17(5): 658–6651365-3156http://hdl.handle.net/10566/457In South Africa, the control of TB and HIV co-infection remains a major challenge despite the availability of international and national guidelines for integration of TB and HIV services. This study was undertaken in KwaZulu-Natal, one of the provinces most affected by both TB and HIV, to identify and understand managers’ and community care workers’ (CCWs) perceptions of health systems barriers related to the implementation of collaborative TB⁄ HIV activities, including prevention of mother to child transmission of HIV (PMTCT). We conducted 29 in-depth interviews with health managers at provincial, district and facility level and with managers of NGOs involved in TB and HIV care, as well as six focus group discussions with CCWs. Thematic analysis of transcripts revealed a convergence of perspectives on the process and the level of the implementation of policy directives on collaborative TB and HIV activities across all categories of respondents (i.e. province-, district-, facility- and communitybased organizations). The majority of participants felt that the implementation of the policy was insufficiently consultative and that leadership and political will were lacking. The predominant themes related to health systems barriers include challenges related to structure and organisational culture; management, planning and power issues; unequal financing; and human resource capacity and regulatory problems notably relating to scope of practice of nurses and CCWs. Accelerated implementation of collaborative TB⁄ HIV activities including PMTCT will require political will and leadership to address these health systems barriers.enThis is the author postprint version of an article published by Wiley-Blackwell. Readers may make use of the material providing due attribution is given.Health systemsBarriersCollaborationIntegrationTBHIVPMTCTArticle