Browsing by Author "Tabana, Hanani"

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    The effectiveness of PMTCT programmes through the measurement of NVP coverage in populations of women delivering in designated areas in the Western Cape Region of South Africa
    (2010) Tabana, Hanani; Coetzee, David
    [Objective] The objective was to assess the uptake and coverage of SD-NVP to prevent mother-to-child transmission of HIV in women of unknown HIV status presenting in labour a sample of delivery sites in the Western Cape. This monitoring activity also accurately measures the prevalence of HIV among pregnant women and ascertains the proportion of HIV exposed infants delivered to these mothers, who received NVP prophylaxis to prevent MTCT. [ Design ] Anonymous, unlinked specimens of cord blood from discarded placentas were tested for HIV antibodies to determine population-level information on HIV infection and NVP coverage among all women delivering in the facilities. Uptake was measured by counting the number of women who were recorded to have accepted NVP when offered while coverage was measured by using the cord blood NVP assay. [ Results ] A total of 2198 (96.5%) cord blood specimens were collected from women at delivery. From these, 1876 (85.4%) women received pre-test counselling. Of those who were counselled, 1851 (84.2%) were tested for HIV and 365 (19.3%) tested positive. Amongst those who were infected, 229 (62.7%) received SD-NVP and but only 57.8% adhered to SD-NVP according to the cord blood. Of the infants born to HIV-infected mothers, 311 (85.2%) were recorded as 9 having received SD-NVP. There was no significant difference in SD-NVP uptake between the two facilities. The overall NVP coverage (mother and infant doses) was 55.3%. [ Conclusions ] The NVP coverage of 55.3% is poor. In order for PMTCT services to be successful, each mother-infant pair should go through a rigorous cascade of events that include HIV testing, receipt of results, diagnosis and drug adherence. The attrition cascade in this study was described using a new cord blood surveillance methodology. Coverage fails for a number of reasons and interventions are likely to differ from one facility to another. Appropriate interventions should be introduced to reduce the transmission to infants.
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    Whole-system change: case study of factors facilitating early implementation of a primary health care reform in a South African province
    (BioMed Central, 2014-11-29) Schneider, Helen; English, Rene; Tabana, Hanani; Padayachee, Thesandree; Orgill, Marsha
    Background: Whole-system interventions are those that entail system wide changes in goals, service delivery arrangements and relationships between actors, requiring approaches to implementation that go beyond projects or programmes. Methods: Drawing on concepts from complexity theory, this paper describes the catalysts to implementation of a whole-system intervention in the North West Province of South Africa. This province was an early adopter of a national primary health care (PHC) strategy that included the establishment of PHC outreach teams based on generalist community health workers. We interviewed a cross section of provincial actors, from senior to frontline, observed processes and reviewed secondary data, to construct a descriptive-explanatory case study of early implementation of the PHC outreach team strategy and the factors facilitating this in the province. Results: Implementation of the PHC outreach team strategy was characterised by the following features: 1) A favourable provincial context of a well established district and sub-district health system and long standing values in support of PHC; 2) The forging of a collective vision for the new strategy that built on prior history and values and that led to distributed leadership and ownership of the new policy; 3) An implementation strategy that ensured alignment of systems (information, human resources) and appropriate sequencing of activities (planning, training, piloting, household campaigns); 4) The privileging of ‘community dialogues’ and local manager participation in the early phases; 5) The establishment of special implementation structures: a PHC Task Team (chaired by a senior provincial manager) to enable feedback and ensure accountability, and an NGO partnership that provided flexible support for implementation. Conclusions: These features resonate with the deliberative, multi-level and context sensitive approaches described as the “simple rules” of successful PHC system change in other settings. Although implementation was not without tensions and weaknesses, particularly at the front-line of the PHC system, the case study highlights how a collective vision can facilitate commitment to and engagement with new policy in complex organisational environments. Successful adoption does not, however, guarantee sustained implementation at scale, and we consider the challenges to further implementation.