Scaling up ART adherence clubs in the public sector health system in the Western Cape, South Africa: a study of the institutionalisation of a pilot innovation

 

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dc.contributor.author MacGregor, Hayley
dc.contributor.author McKenzie, Andrew
dc.contributor.author Jacobs, Tanya
dc.contributor.author Ullauri, Angelica
dc.date.accessioned 2018-05-03T11:18:30Z
dc.date.available 2018-05-03T11:18:30Z
dc.date.issued 2018-04-25
dc.identifier.citation MacGregor, H., McKenzie, A., Jacobs, T., & Ullauri, A. (2018). Scaling up ART adherence clubs in the public sector health system in the Western Cape, South Africa: a study of the institutionalisation of a pilot innovation. Globalization and health, 14(1), 40.
dc.identifier.uri https://doi.org/10.1186/s12992-018-0351-z
dc.identifier.uri http://hdl.handle.net/11427/27864
dc.description.abstract Background: In 2011, a decision was made to scale up a pilot innovation involving ‘adherence clubs’ as a form of differentiated care for HIV positive people in the public sector antiretroviral therapy programme in the Western Cape Province of South Africa. In 2016 we were involved in the qualitative aspect of an evaluation of the adherence club model, the overall objective of which was to assess the health outcomes for patients accessing clubs through epidemiological analysis, and to conduct a health systems analysis to evaluate how the model of care performed at scale. In this paper we adopt a complex adaptive systems lens to analyse planned organisational change through intervention in a state health system. We explore the challenges associated with taking to scale a pilot that began as a relatively simple innovation by a non-governmental organisation. Results: Our analysis reveals how a programme initially representing a simple, unitary system in terms of management and clinical governance had evolved into a complex, differentiated care system. An innovation that was assessed as an excellent idea and received political backing, worked well whilst supported on a small scale. However, as scaling up progressed, challenges have emerged at the same time as support has waned. We identified a ‘tipping point’ at which the system was more likely to fail, as vulnerabilities magnified and the capacity for adaptation was exceeded. Yet the study also revealed the impressive capacity that a health system can have for catalysing novel approaches. Conclusions: We argue that innovation in largescale, complex programmes in health systems is a continuous process that requires ongoing support and attention to new innovation as challenges emerge. Rapid scaling up is also likely to require recourse to further resources, and a culture of iterative learning to address emerging challenges and mitigate complex system errors. These are necessary steps to the future success of adherence clubs as a cornerstone of differentiated care. Further research is needed to assess the equity and quality outcomes of a differentiated care model and to ensure the inclusive distribution of the benefits to all categories of people living with HIV.
dc.language.iso en
dc.publisher BioMed Central
dc.source Globalization and Health
dc.source.uri https://globalizationandhealth.biomedcentral.com/
dc.source.uri https://globalizationandhealth.biomedcentral.com/
dc.subject.other HIV
dc.subject.other South Africa
dc.subject.other Health system
dc.subject.other Complex adaptive systems
dc.subject.other Innovation
dc.subject.other Scaling up
dc.subject.other Chronic illness
dc.subject.other Differentiated HIV care
dc.subject.other ART adherence
dc.title Scaling up ART adherence clubs in the public sector health system in the Western Cape, South Africa: a study of the institutionalisation of a pilot innovation
dc.type Journal Article
dc.date.updated 2018-04-29T03:28:08Z
dc.rights.holder The Author(s).
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Division of Infectious Disease and HIV Med en_ZA
uct.type.filetype Text
uct.type.filetype Image
dc.identifier.apacitation MacGregor, H., McKenzie, A., Jacobs, T., & Ullauri, A. (2018). Scaling up ART adherence clubs in the public sector health system in the Western Cape, South Africa: a study of the institutionalisation of a pilot innovation. <i>Globalization and Health</i>, http://hdl.handle.net/11427/27864 en_ZA
dc.identifier.chicagocitation MacGregor, Hayley, Andrew McKenzie, Tanya Jacobs, and Angelica Ullauri "Scaling up ART adherence clubs in the public sector health system in the Western Cape, South Africa: a study of the institutionalisation of a pilot innovation." <i>Globalization and Health</i> (2018) http://hdl.handle.net/11427/27864 en_ZA
dc.identifier.vancouvercitation MacGregor H, McKenzie A, Jacobs T, Ullauri A. Scaling up ART adherence clubs in the public sector health system in the Western Cape, South Africa: a study of the institutionalisation of a pilot innovation. Globalization and Health. 2018; http://hdl.handle.net/11427/27864. en_ZA
dc.identifier.ris TY - Journal Article AU - MacGregor, Hayley AU - McKenzie, Andrew AU - Jacobs, Tanya AU - Ullauri, Angelica AB - Background: In 2011, a decision was made to scale up a pilot innovation involving ‘adherence clubs’ as a form of differentiated care for HIV positive people in the public sector antiretroviral therapy programme in the Western Cape Province of South Africa. In 2016 we were involved in the qualitative aspect of an evaluation of the adherence club model, the overall objective of which was to assess the health outcomes for patients accessing clubs through epidemiological analysis, and to conduct a health systems analysis to evaluate how the model of care performed at scale. In this paper we adopt a complex adaptive systems lens to analyse planned organisational change through intervention in a state health system. We explore the challenges associated with taking to scale a pilot that began as a relatively simple innovation by a non-governmental organisation. Results: Our analysis reveals how a programme initially representing a simple, unitary system in terms of management and clinical governance had evolved into a complex, differentiated care system. An innovation that was assessed as an excellent idea and received political backing, worked well whilst supported on a small scale. However, as scaling up progressed, challenges have emerged at the same time as support has waned. We identified a ‘tipping point’ at which the system was more likely to fail, as vulnerabilities magnified and the capacity for adaptation was exceeded. Yet the study also revealed the impressive capacity that a health system can have for catalysing novel approaches. Conclusions: We argue that innovation in largescale, complex programmes in health systems is a continuous process that requires ongoing support and attention to new innovation as challenges emerge. Rapid scaling up is also likely to require recourse to further resources, and a culture of iterative learning to address emerging challenges and mitigate complex system errors. These are necessary steps to the future success of adherence clubs as a cornerstone of differentiated care. Further research is needed to assess the equity and quality outcomes of a differentiated care model and to ensure the inclusive distribution of the benefits to all categories of people living with HIV. DA - 2018-04-25 DB - OpenUCT DP - University of Cape Town J1 - Globalization and Health LK - https://open.uct.ac.za PB - University of Cape Town PY - 2018 T1 - Scaling up ART adherence clubs in the public sector health system in the Western Cape, South Africa: a study of the institutionalisation of a pilot innovation TI - Scaling up ART adherence clubs in the public sector health system in the Western Cape, South Africa: a study of the institutionalisation of a pilot innovation UR - http://hdl.handle.net/11427/27864 ER - en_ZA


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