Evaluation of the integration of the comprehensive care management and treatment plan for HIV and AIDS in Ekurhuleni and Sedibeng district health services

research report submitted to the School of Public Health, University of the Witwatersrand in partial fulfillment of the requirements for the degree of Master of Public Health. May 2015Introduction HIV and AIDS in South Africa has a considerable disease burden which places an enormous strain on the health care system. The increased workloads brought about by testing and counseling, prevention, treatment, care and support services with a concomitant decrease in the supply of health care workers impacts negatively on the quality of services. Health planners and managers need to implement approaches that enable maximum utilisation of available resources by integrating HIV and AIDS into the normal functioning of existing programmes to address increasing demands for HIV and AIDS services and to strengthen the health care system. Aim and Objectives The aim of the study was to describe the extent of integration of HIV and AIDS services at the different levels of care in the district health system. Method This is a descriptive cross sectional study that used structured pretested interview questionnaires, data review and a facility check list. A stratified random sample of five facilities that were accredited in the district from 2004 – 2007 was used. Fifty two interviews were conducted face to face with facility managers, doctors, nurses, dieticians, social workers, and lay counselors and seventeen self-administered questionnaires were completed by district programme managers. A total of 69 interviews were conducted. Results The study highlighted the fact that most of the facilities (96%) implemented the HIV and AIDS programme without a documented operational plan. Stakeholder participation on planning was limited at less than 30% across all levels of services within the district. Budgeting and resource allocation operated independently from the district and facility financial systems resulting in parallel systems. Technical support and programme reviews by the district and provincial managers were weak and irregular. Support of HIV and AIDS services was mainly given by facility management. The district`s monitoring and evaluation systems were not in place. The referral systems between the facilities and community structures were not well established. Lay counselors skills on PMTCT and nutrition was rated the lowest and compromised the implementation of an integrated approach. HIV and AIDS services were not implemented at well baby clinics. Conclusions The findings of this study suggests that the HIV and AIDS services have developed into separate vertical administrative and reporting systems operating differently from the mainstream services and not supporting the strengthening of the health care system and therefore not capable of achieving the intended goal of the programme

Community health workers and accountability: Reflections from an international "think-in"

Community health workers (CHWs) are frequently put forward as a remedy for lack of health system capacity, including challenges associated with health service coverage and with low community engagement in the health system, and expected to enhance or embody health system accountability. During a ‘think in’, held in June of 2017, a diverse group of practitioners and researchers discussed the topic of CHWs and their possible roles in a larger “accountability ecosystem.” This jointly authored commentary resulted from our deliberations. While CHWs are often conceptualized as cogs in a mechanistic health delivery system, at the end of the day, CHWs are people embedded in families, communities, and the health system. CHWs’ social position and professional role influence how they are treated and trusted by the health sector and by community members, as well as when, where, and how they can exercise agency and promote accountability. To that end, we put forward several propositions for further conceptual development and research related to the question of CHWs and accountability.publishedVersio

Community health workers and accountability: reflections from an international “think-in”

Community health workers (CHWs) are frequently put forward as a remedy for lack of health system capacity, including challenges associated with health service coverage and with low community engagement in the health system, and expected to enhance or embody health system accountability. During a ‘think in’, held in June of 2017, a diverse group of practitioners and researchers discussed the topic of CHWs and their possible roles in a larger “accountability ecosystem.” This jointly authored commentary resulted from our deliberations. While CHWs are often conceptualized as cogs in a mechanistic health delivery system, at the end of the day, CHWs are people embedded in families, communities, and the health system. CHWs’ social position and professional role influence how they are treated and trusted by the health sector and by community members, as well as when, where, and how they can exercise agency and promote accountability. To that end, we put forward several propositions for further conceptual development and research related to the question of CHWs and accountability