Implementing a multi-sectoral response to HIV: a case study of AIDS councils in the Mpumalanga Province, South Africa

Abstract

Background: A multi-sectoral response is advocated by international organisations as a good strategy to address the multiple drivers and impact of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), and was historically mandated as a condition of funding. In March 2017, the South African National AIDS Council (SANAC) launched the latest 5 year National Strategic Plan (NSP) to address HIV, sexually transmitted infections and tuberculosis. As with previous iterations, the NSP calls for multi-sectoral action (MSA) and mandates AIDS councils (ACs) at different levels to coordinate its implementation. Efforts have been made to advocate for the adoption of MSA in South Africa, yet evaluation of these efforts is currently limited. Objective: This paper assesses the implementation of a multi-sectoral response to HIV in South Africa, through a case study of the Mpumalanga Province. Methods: We identified and reviewed key policy documents, conducted 12 interviews and held six focus group discussions. We also drew on our involvement, through participant observation, in the development of NSPs and in AC meetings. Results: SANAC is struggling to provide much-needed support to provincial, district and local ACs. Therefore, most ACs are generally weak and failing to implement MSA. Membership is voluntary, there is a lack of sustained commitment and they do not include representatives from all sectors. There is little capacity to undertake the activities necessary for coordinating the implementation of MSA, and unclear roles and responsibilities within ACs result in divisions and tension between sectors. There is inadequate senior political leadership and funding to facilitate effective implementation of MSA. Conclusion: We identified three interventions that we argue are required to support the effective implementation of MSA: strengthening and stabilising the SANAC structure; building capacity of ACs; and creating an enabling environment for effective implementation of MSA through political leadership, support and resourcing of the HIV response.

Multisectoral (in)action: towards effective mainstreaming of HIV in public sector departments in South Africa

“…Respondents in KIIs alluded to the difficulty of measuring impact of programmes when multiple actors are involved, which they understood to be one of the factors that explains poor collaboration in HIV programmes. We also found that lack of participation by some government departments in platforms that are meant to create space for collaboration between departments, renders these forums ineffective, as was observed elsewhere (Mahlangu, Vearey, Thomas, & Goudge, 2017).…”

“…This paper focuses on mainstreaming of HIV in the public sector in South Africa. Involvement, of civil society and the private sector in the multisectoral response to HIV in South Africa is reported elsewhere (Mahlangu, Vearey, Thomas, & Goudge, 2017).…”

Towards a framework for multisector and multilevel collaboration: case of HIV and AIDS governance in South Africa

“…The study highlighted that these structures experience challenges in implementing a multisector approach. Detailed methods and full presentation of findings are discussed elsewhere [35,36]. Tables 1 and 2 presents a summary of the challenges.…”

Achieving 90-90-90: A Focus on Sero-Discordant Couples

“…In regions with high HIV prevalence, proportions of sero-discordant intra-couple transmission range from 13.0 to 55% of new HIV infections [14]. For South Africa, the estimated proportion of sero-discordant couples is unclear, however, transmission among longer-term couples were estimated above 10.0% per year [15]. Thus the prevention of intra-couple HIV transmission may delay the progression of the epidemic.…”

“…Since the start of the new millennium, the management of HIV was spearheaded by comprehensive, multi-sectorial action orientated National Strategic Plans for HIV/AIDS and Sexually Transmitted Infections [15]. Over the last 18 years, many gains have been made in curbing the HIV epidemic.…”