An evaluation of the implementation of the 3-tiered ART monitoring system in South Africa

dc.contributor.advisorBoulle, Andrewen_ZA
dc.contributor.advisorBarron, Peteren_ZA
dc.contributor.authorWhite, Catherineen_ZA
dc.date.accessioned2017-01-19T12:25:13Z
dc.date.available2017-01-19T12:25:13Z
dc.date.issued2016en_ZA
dc.description.abstractBackground and Purpose: South Africa has the largest public antiretroviral (ART) service in the world but until recently it was unable to report from primary sources the numbers of patients on ART and was unable to monitor the program outcomes using routine data. In December 2010 the South Africa National Department of Health adopted a standardized ART monitoring strategy referred to as the 3-Tiered Strategy. The System provides facilities with different options for cohort monitoring based on the resources and infrastructure available. The technical design of the three tiers is pragmatic and appropriate to the facility-level context. The process to implement the System was articulated through an implementation plan. The health management information system was aligned to collate data produced by the System and standard operating procedures were produced to guide system use. Methods: The study comprised a mixed-methods approach to evaluate the implementation of the system in accordance with the implementation plan. Program data were analysed, program documents were reviewed and key informants were interviewed in order to capture the complex and multidimensional nature of the countrywide implementation activities. Results: By October 2014 full implementation had been achieved in 2,139 ART facilities, of a total 3,772 facilities that report ART data. And, of facilities that had reached full implementation, 87% of facilities had submitted data. At the time of analysis, the outcome data available were representative of 55% of active patients on ART. Qualitative results elicited facility-level challenges as well as structural barriers to effective implementation. The study demonstrated that South Africa's introduction of the 3-Tiered Strategy for ART monitoring was championed by senior management in the NDOH who fostered a collaborative environment and structured implementation approach which resulted in wide-scale uptake of the recommended systems, predominantly the electronic register. Conclusions: The implementation of a basics first health information system has yielded a complete set of enrolment and retention on ART data; however there are systemic and structural barriers to the sustainable production of these and additional cohort outcome data. The study has brought attention to the organizational restructuring and the holistic health system interventions required to implement such a system.en_ZA
dc.identifier.apacitationWhite, C. (2016). <i>An evaluation of the implementation of the 3-tiered ART monitoring system in South Africa</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine. Retrieved from http://hdl.handle.net/11427/22825en_ZA
dc.identifier.chicagocitationWhite, Catherine. <i>"An evaluation of the implementation of the 3-tiered ART monitoring system in South Africa."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2016. http://hdl.handle.net/11427/22825en_ZA
dc.identifier.citationWhite, C. 2016. An evaluation of the implementation of the 3-tiered ART monitoring system in South Africa. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - White, Catherine AB - Background and Purpose: South Africa has the largest public antiretroviral (ART) service in the world but until recently it was unable to report from primary sources the numbers of patients on ART and was unable to monitor the program outcomes using routine data. In December 2010 the South Africa National Department of Health adopted a standardized ART monitoring strategy referred to as the 3-Tiered Strategy. The System provides facilities with different options for cohort monitoring based on the resources and infrastructure available. The technical design of the three tiers is pragmatic and appropriate to the facility-level context. The process to implement the System was articulated through an implementation plan. The health management information system was aligned to collate data produced by the System and standard operating procedures were produced to guide system use. Methods: The study comprised a mixed-methods approach to evaluate the implementation of the system in accordance with the implementation plan. Program data were analysed, program documents were reviewed and key informants were interviewed in order to capture the complex and multidimensional nature of the countrywide implementation activities. Results: By October 2014 full implementation had been achieved in 2,139 ART facilities, of a total 3,772 facilities that report ART data. And, of facilities that had reached full implementation, 87% of facilities had submitted data. At the time of analysis, the outcome data available were representative of 55% of active patients on ART. Qualitative results elicited facility-level challenges as well as structural barriers to effective implementation. The study demonstrated that South Africa's introduction of the 3-Tiered Strategy for ART monitoring was championed by senior management in the NDOH who fostered a collaborative environment and structured implementation approach which resulted in wide-scale uptake of the recommended systems, predominantly the electronic register. Conclusions: The implementation of a basics first health information system has yielded a complete set of enrolment and retention on ART data; however there are systemic and structural barriers to the sustainable production of these and additional cohort outcome data. The study has brought attention to the organizational restructuring and the holistic health system interventions required to implement such a system. DA - 2016 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2016 T1 - An evaluation of the implementation of the 3-tiered ART monitoring system in South Africa TI - An evaluation of the implementation of the 3-tiered ART monitoring system in South Africa UR - http://hdl.handle.net/11427/22825 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/22825
dc.identifier.vancouvercitationWhite C. An evaluation of the implementation of the 3-tiered ART monitoring system in South Africa. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2016 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/22825en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDepartment of Public Health and Family Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherPublic Healthen_ZA
dc.titleAn evaluation of the implementation of the 3-tiered ART monitoring system in South Africaen_ZA
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationnameMPHen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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