Evaluation of the integration of the comprehensive care management and treatment plan for HIV and AIDS in Ekurhuleni and Sedibeng district health services
Date
2015-09-08
Authors
Maboe, Thoko Mercy
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Introduction
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.
Description
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 2015