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Scaling up integration: development and results of a participatory assessment of HIV/TB services, South Africa.

Scott V, Chopra M, Azevedo V, Caldwell J, Naidoo P, Smuts B - Health Res Policy Syst (2010)

Bottom Line: In South Africa the need to integrate HIV, TB and STI programmes has been recognised at a policy and organisation level; the challenge is now one of translating policies into relevant actions and monitoring implementation to ensure that the anticipated benefits of integration are achieved.The tool was extensively piloted in two rounds involving 49 clinics in 2003 and 2004 to identify data necessary for effective facility-level management.This use of the tool which is designed to empower programme and facility managers demonstrates how engaging middle managers is crucial in translating policies into relevant actions.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Public Health, University of the Western Cape, Modderdam Road, Bellville, Cape Town, 7535, South Africa. verascott@mweb.co.za.

ABSTRACT

Background: In South Africa the need to integrate HIV, TB and STI programmes has been recognised at a policy and organisation level; the challenge is now one of translating policies into relevant actions and monitoring implementation to ensure that the anticipated benefits of integration are achieved. In this research, set in public primary care services in Cape Town, South Africa, we set out to determine how middle level managers could be empowered to monitor the implementation of an effective, integrated HIV/TB/STI service.

Methods: A team of managers and researchers designed an evaluation tool to measure implementation of key components of an integrated HIV/TB/STI package with a focus on integration. They used a comprehensive health systems framework based on conditions for programme effectiveness and then identified and collected tracer indicators. The tool was extensively piloted in two rounds involving 49 clinics in 2003 and 2004 to identify data necessary for effective facility-level management. A subsequent evaluation of 16 clinics (2 per health sub district, 12% of all public primary care facilities) was done in February 2006.

Results: 16 clinics were reviewed and 635 records sampled. Client access to HIV/TB/STI programmes was limited in that 50% of facilities routinely deferred clients. Whilst the physical infrastructure and staff were available, there was problem with capacity in that there was insufficient staff training (for example, only 40% of clinical staff trained in HIV care). Weaknesses were identified in quality of care (for example, only 57% of HIV clients were staged in accordance with protocols) and continuity of care (for example, only 24% of VCT clients diagnosed with HIV were followed up for medical assessment). Facility and programme managers felt that the evaluation tool generated information that was useful to manage the programmes at facility and district level. On the basis of the results facility managers drew up action plans to address three areas of weakness within their own facility.

Conclusions: This use of the tool which is designed to empower programme and facility managers demonstrates how engaging middle managers is crucial in translating policies into relevant actions.

No MeSH data available.


Related in: MedlinePlus

Summary of key steps in the development of HIV/TB/STI evaluation tool. ➢ Definition of purpose of the tool. ➢ Selection and modification of a framework to guide the evaluation. ➢ Identification of the components of the existing TB and HIV programmes that correspond with the WHO suggested key HIV/TB package for middle-income countries. ➢ Development of a full list of possible indicators of programme effectiveness. ➢ Development of criteria to select tracer indicators to use in evaluation. ➢ Review of existing data sources to ascertain what information is already available to use in the evaluation. ➢ Development of facility audit tools to collect data not routinely available
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Figure 1: Summary of key steps in the development of HIV/TB/STI evaluation tool. ➢ Definition of purpose of the tool. ➢ Selection and modification of a framework to guide the evaluation. ➢ Identification of the components of the existing TB and HIV programmes that correspond with the WHO suggested key HIV/TB package for middle-income countries. ➢ Development of a full list of possible indicators of programme effectiveness. ➢ Development of criteria to select tracer indicators to use in evaluation. ➢ Review of existing data sources to ascertain what information is already available to use in the evaluation. ➢ Development of facility audit tools to collect data not routinely available

Mentions: A task team consisting of three district programme managers who were responsible for HIV, TB and STIs, one sub district manager and two academics was formed to develop a process for integrating HIV and TB services, and comprised the core research team. Other district managers contributed on an ad hoc basis. This team prioritised the need to evaluate the existing programmes especially with a focus on the degree to which integration was occurring. They met on a monthly basis over 18 months to establish a monitoring and evaluation framework and develop appropriate indicators (Figure 1).


Scaling up integration: development and results of a participatory assessment of HIV/TB services, South Africa.

Scott V, Chopra M, Azevedo V, Caldwell J, Naidoo P, Smuts B - Health Res Policy Syst (2010)

Summary of key steps in the development of HIV/TB/STI evaluation tool. ➢ Definition of purpose of the tool. ➢ Selection and modification of a framework to guide the evaluation. ➢ Identification of the components of the existing TB and HIV programmes that correspond with the WHO suggested key HIV/TB package for middle-income countries. ➢ Development of a full list of possible indicators of programme effectiveness. ➢ Development of criteria to select tracer indicators to use in evaluation. ➢ Review of existing data sources to ascertain what information is already available to use in the evaluation. ➢ Development of facility audit tools to collect data not routinely available
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2913937&req=5

Figure 1: Summary of key steps in the development of HIV/TB/STI evaluation tool. ➢ Definition of purpose of the tool. ➢ Selection and modification of a framework to guide the evaluation. ➢ Identification of the components of the existing TB and HIV programmes that correspond with the WHO suggested key HIV/TB package for middle-income countries. ➢ Development of a full list of possible indicators of programme effectiveness. ➢ Development of criteria to select tracer indicators to use in evaluation. ➢ Review of existing data sources to ascertain what information is already available to use in the evaluation. ➢ Development of facility audit tools to collect data not routinely available
Mentions: A task team consisting of three district programme managers who were responsible for HIV, TB and STIs, one sub district manager and two academics was formed to develop a process for integrating HIV and TB services, and comprised the core research team. Other district managers contributed on an ad hoc basis. This team prioritised the need to evaluate the existing programmes especially with a focus on the degree to which integration was occurring. They met on a monthly basis over 18 months to establish a monitoring and evaluation framework and develop appropriate indicators (Figure 1).

Bottom Line: In South Africa the need to integrate HIV, TB and STI programmes has been recognised at a policy and organisation level; the challenge is now one of translating policies into relevant actions and monitoring implementation to ensure that the anticipated benefits of integration are achieved.The tool was extensively piloted in two rounds involving 49 clinics in 2003 and 2004 to identify data necessary for effective facility-level management.This use of the tool which is designed to empower programme and facility managers demonstrates how engaging middle managers is crucial in translating policies into relevant actions.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Public Health, University of the Western Cape, Modderdam Road, Bellville, Cape Town, 7535, South Africa. verascott@mweb.co.za.

ABSTRACT

Background: In South Africa the need to integrate HIV, TB and STI programmes has been recognised at a policy and organisation level; the challenge is now one of translating policies into relevant actions and monitoring implementation to ensure that the anticipated benefits of integration are achieved. In this research, set in public primary care services in Cape Town, South Africa, we set out to determine how middle level managers could be empowered to monitor the implementation of an effective, integrated HIV/TB/STI service.

Methods: A team of managers and researchers designed an evaluation tool to measure implementation of key components of an integrated HIV/TB/STI package with a focus on integration. They used a comprehensive health systems framework based on conditions for programme effectiveness and then identified and collected tracer indicators. The tool was extensively piloted in two rounds involving 49 clinics in 2003 and 2004 to identify data necessary for effective facility-level management. A subsequent evaluation of 16 clinics (2 per health sub district, 12% of all public primary care facilities) was done in February 2006.

Results: 16 clinics were reviewed and 635 records sampled. Client access to HIV/TB/STI programmes was limited in that 50% of facilities routinely deferred clients. Whilst the physical infrastructure and staff were available, there was problem with capacity in that there was insufficient staff training (for example, only 40% of clinical staff trained in HIV care). Weaknesses were identified in quality of care (for example, only 57% of HIV clients were staged in accordance with protocols) and continuity of care (for example, only 24% of VCT clients diagnosed with HIV were followed up for medical assessment). Facility and programme managers felt that the evaluation tool generated information that was useful to manage the programmes at facility and district level. On the basis of the results facility managers drew up action plans to address three areas of weakness within their own facility.

Conclusions: This use of the tool which is designed to empower programme and facility managers demonstrates how engaging middle managers is crucial in translating policies into relevant actions.

No MeSH data available.


Related in: MedlinePlus