Administrative integration of vertical HIV monitoring and evaluation into health systems: a case study from South Africa
نویسندگان
چکیده
BACKGROUND In 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. OBJECTIVE To 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. METHODS This 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. RESULTS Relative 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. CONCLUSIONS This 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.
منابع مشابه
Measuring administrative integration of disease control programmes within health systems: a case study of HIV monitoring and evaluation in South Africa
Background In South Africa, integrating the management of health services at a decentralized district level within the authority of general health service (GHS) managers is a reform priority. The reforms promote administrative integration, i.e. transfer of administrative authority over disease control programmes (DCPs) from DCP managers to GHS managers and re-defining DCP manager roles from imp...
متن کاملAligning vertical interventions to health systems: a case study of the HIV monitoring and evaluation system in South Africa
BACKGROUND Like many low- and middle-income countries, South Africa established a dedicated HIV monitoring and evaluation (M&E) system to track the national response to HIV/AIDS. Its implementation in the public health sector has however not been assessed. Since responsibility for health services management lies at the district (sub-national) level, this study aimed to assess the extent to whic...
متن کاملGlobal Health Diplomacy, National Integration, and Regional Development through the Monitoring and Evaluation of HIV/AIDS Programs in Papua New Guinea, Vanuatu, and Samoa
The South Pacific countries of Vanuatu, Samoa, and Papua New Guinea have ascended rapidly up the development spectrum in recent years, refining an independent and post-colonial economic and political identity that enhances their recognition on the world stage. All three countries have overcome economic, political and public health challenges in order to stake their claim to sovereignty. In this...
متن کاملDevelopment of hardware system using temperature and vibration maintenance models integration concepts for conventional machines monitoring: a case study
This article describes the integration of temperature and vibration models for maintenance monitoring of conventional machinery parts in which their optimal and best functionalities are affected by abnormal changes in temperature and vibration values thereby resulting in machine failures, machines breakdown, poor quality of products, inability to meeting customers’ demand, poor inventory contro...
متن کاملKey informant perspectives on policy- and service-level challenges and opportunities for delivering integrated sexual and reproductive health and HIV care in South Africa
BACKGROUND Integration of sexual and reproductive health (SRH) and HIV services is a policy priority, both globally and in South Africa. Recent studies examining SRH/HIV integration in South Africa have focused primarily on the SRH needs of HIV patients, and less on the policy and service-delivery environment in which these programs operate. To fill this gap we undertook a qualitative study to ...
متن کامل