Aligning vertical interventions to health systems: a case study of the HIV monitoring and evaluation system in South Africa

Kawonga, Mary; Blaauw, Duane; Fonn, Sharon

doi:10.1186/1478-4505-10-2

Cited by 46 publications

(62 citation statements)

References 29 publications

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“…It is, however, important to note that the challenges affecting health information systems are complex and multifactorial and that capacity development initiatives must be implemented alongside other system-strengthening initiatives to have the most substantive impact. This would include initiatives to implement electronic data management systems [9,17], instill a culture of data use [27], and harmonize data collection efforts [17,26,28,29]. …”

Section: Discussionmentioning

confidence: 99%

Establishing a health information workforce: innovation for low- and middle-income countries

et al. 2013

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BackgroundTo address the shortage of health information personnel within Botswana, an innovative human resources approach was taken. University graduates without training or experience in health information or health sciences were hired and provided with on-the-job training and mentoring to create a new cadre of health worker: the district Monitoring and Evaluation (M&E) Officer. This article describes the early outcomes, achievements, and challenges from this initiative.MethodsData were collected from the district M&E Officers over a 2-year period and included a skills assessment at baseline and 12 months, pre- and post-training tests, interviews during stakeholder site visits, a survey of achievements, focus group discussions, and an attrition assessment.ResultsAn average of 2.7 mentoring visits were conducted for M&E Officers in each district. There were five training sessions over 18 months. Knowledge scores significantly increased (p < 0.05) during the three trainings in which pre/post tests were administered. Over 1 year, there were significant improvements (p < 0.05) in self-rated skills related to computer literacy, checking data validity, implementing data quality procedures, using data to support program planning, proposing indicators, and writing M&E reports. Out of the 34 district M&E Officers interviewed during site visits, most were conducting facility visits to review data (27/34; 79%), comparing data sets over time (31/34; 91%), backing up data (32/34; 94%), and analyzing data (32/34; 94%). Common challenges included late facility reports (28/34; 82%), lack of transportation (22/34; 65%), inaccurate facility reports (10/34; 29%), and colleagues’ misunderstanding of M&E (10/34; 29%). Six posts were vacated in the first year (6/51; 12%). A total of 49 Officers completed the achievements survey; of these, common accomplishments related to improvements in data management (35/49; 71%), data quality (31/49; 63%), data use (29/49; 59%), and capacity development (26/49; 53%).ConclusionsThe development of a cadre of district M&E Officers has contributed positively to the health information system in Botswana. In the absence of tertiary training related to health information, on-the-job training and mentoring of university graduates can be an effective approach for developing a new professional cadre of M&E expertise and for strengthening capacity within a national health system.

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Section: Discussionmentioning

confidence: 99%

Establishing a health information workforce: innovation for low- and middle-income countries

et al. 2013

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“…Also, several sub-programmes (e.g. for HIV counselling and testing [HCT], prevention of mother-to-child HIV transmission [PMTCT], and ART) have been established within the HIV programme and are coordinated in separate silos, indicating further verticalisation (24). This is at odds with current health sector decentralisation reforms that envisage integrated health management under the control of horizontal managers at district level.…”

Section: Vertical Programmes and The Health System In South Africamentioning

confidence: 99%

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

Kawonga

Fonn

Blaauw

2013

Global Health Action

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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.

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“…There is mounting evidence suggesting that vertical HIV service delivery is unconducive to long-term programme sustainability and that the integration of HIV services into general care, reduces services delivery costs as well as duplication and fosters synergies in health systems especially in resource-constrained settings such as Uganda [4–6, 8]. …”

Section: Introductionmentioning

confidence: 99%

Understanding the persistence of vertical (stand-alone) HIV clinics in the health system in Uganda: a qualitative synthesis of patient and provider perspectives

Zakumumpa

Rujumba

Kwiringira

et al. 2018

BMC Health Serv Res

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BackgroundAlthough there is mounting evidence and policy guidance urging the integration of HIV services into general health systems in countries with a high HIV burden, vertical (stand-alone) HIV clinics are still common in Uganda. We sought to describe the specific contexts underpinning the endurance of vertical HIV clinics in Uganda.MethodsA qualitative research design was adopted. Semi-structured interviews were conducted with the heads of HIV clinics, clinicians and facility in-charges (n = 78), coupled with eight focus group discussions (64 participants) with patients from 16 health facilities purposively selected, from a nationally-representative sample of 195 health facilities across Uganda, because they run stand-alone HIV clinics. Data were analyzed by thematic approach as guided by the theory proposed by Shediac-Rizkallah & Bone (1998) which identifies; Intervention characteristics, organizational context, and broader environment factors as potentially influential on health programme sustainability.ResultsIntervention characteristics: Provider stigma was reported to have been widespread in the integrated care experience of participating health facilities which necessitated the establishment of stand-alone HIV clinics. HIV disease management was described as highly specialized which necessitated a dedicated workforce and vertical HIV infrastructure such as counselling rooms. Organizational context: Participating health facilities reported health-system capacity constraints in implementing integrated systems of care due to a shortage of ART-proficient personnel and physical space, a lack of laboratory capacity to concurrently conduct HIV and non-HIV tests and increased workloads associated with implementing integrated care. Broader environment factors: Escalating HIV client loads and external HIV funding architectures were perceived to have perpetuated verticalized HIV programming over the past decade.ConclusionOur study offers in-depth, contextualized insights into the factors contributing to the endurance of vertical HIV clinics in Uganda. Our analysis suggests that there is a complex interaction in supply-side constraints (shortage of ART-proficient personnel, increased workloads, laboratory capacity deficiencies) and demand-side factors (escalating demand for HIV services, psychosocial barriers to HIV care) as well as the specialized nature of HIV disease management which pose challenges to the integrated-health services agenda.

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Aligning vertical interventions to health systems: a case study of the HIV monitoring and evaluation system in South Africa

Cited by 46 publications

References 29 publications

Establishing a health information workforce: innovation for low- and middle-income countries

Establishing a health information workforce: innovation for low- and middle-income countries

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

Understanding the persistence of vertical (stand-alone) HIV clinics in the health system in Uganda: a qualitative synthesis of patient and provider perspectives

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