Administrative integration of vertical HIV monitoring and evaluation into health systems: a case study from South Africa

Abstract

BackgroundIn light of an increasing global focus on health system strengthening and integration of vertical programmes within health systems, methods and tools are required to examine whether general health service managers exercise administrative authority over vertical programmes.ObjectiveTo measure the extent to which general health service (horizontal) managers, exercise authority over the HIV programme's monitoring and evaluation (M&E) function, and to explore factors that may influence this exercise of authority.MethodsThis cross-sectional survey involved interviews with 51 managers. We drew ideas from the concept of ‘exercised decision-space’ – traditionally used to measure local level managers’ exercise of authority over health system functions following decentralisation. Our main outcome measure was the degree of exercised authority – classified as ‘low’, ‘medium’ or ‘high’ – over four M&E domains (HIV data collection, collation, analysis, and use). We applied ordinal logistic regression to assess whether actor type (horizontal or vertical) was predictive of a higher degree of exercised authority, independent of management capacity (training and experience), and M&E knowledge.ResultsRelative to vertical managers, horizontal managers had lower HIV M&E knowledge, were more likely to exercise a higher degree of authority over HIV data collation (OR 7.26; CI: 1.9, 27.4), and less likely to do so over HIV data use (OR 0.19; CI: 0.05, 0.84). A higher HIV M&E knowledge score was predictive of a higher exercised authority over HIV data use (OR 1.22; CI: 0.99, 1.49). There was no association between management capacity and degree of authority.ConclusionsThis study demonstrates a HIV M&E model that is neither fully vertical nor integrated. The HIV M&E is characterised by horizontal managers producing HIV information while vertical managers use it. This may undermine policies to strengthen integrated health system planning and management under the leadership of horizontal managers.

Exploring the Information and ICT Skills of Health Professionals in Low- and Middle-Income Countries

“…"they don't pick up the errors, so they are not Program people; they're just punching numbers ... because for us from Programs you can very easily spot something that looks funny ... ... whereas someone who's just punching number; if they punch 1, 2, 3 … 1, 2, 3, 48 they won't necessarily think about the 48, whereas you would immediately realize that, that 48 can't be." (Informant in Program Management) This is consistent with the results from another South African case study [33]. The researchers assessed the degree to which general health service (horizontal) managers exercise authority over the HIV program's M&E function, namely, HIV data collection, collation, analysis and use.…”

“…The researchers assessed the degree to which general health service (horizontal) managers exercise authority over the HIV program's M&E function, namely, HIV data collection, collation, analysis and use. They found that compared to vertical managers, i.e., managers working in a disease-specific (HIV) position, horizontal managers had lower HIV M&E knowledge, and were more likely to produce HIV data but less likely to use it [33].…”

Exploring the Functioning of Decision Space: A Review of the Available Health Systems Literature

“…21,23,28,32,33,71,72 For example, in South Africa, as a result of deconcentration from the National Department of Health to local departments, and devolution from national to local governments, health services were then accountable to both local and national government which led to confusion about priority setting and planning. 20 …”

Evaluation of an integrated HIV and hypertension management model in rural South Africa: a mixed methods approach

“…The failure to achieve optimal BP control in the study setting may be attributed to health system factors. First, a study showed that the vertical HIV programme was not administratively integrated with the horizontal general health system in South Africa [45]. Second, the quality of care study, which used a quantitative approach, showed that five of the eight priority domains of care in the integrated model were not associated with good quality care in the pilot facilities [6].…”