Implementation of an electronic monitoring and evaluation system for the antiretroviral treatment programme in the Cape Winelands district, South Africa: a qualitative evaluation

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dc.contributor.authorMyburgh, Hanlieen_ZA
dc.contributor.authorMurphy, Joshua Pen_ZA
dc.contributor.authorvan Huyssteen, Meaen_ZA
dc.contributor.authorFoster, Nicolaen_ZA
dc.contributor.authorGrobbelaar, Cornelius Jen_ZA
dc.contributor.authorStruthers, Helen Een_ZA
dc.contributor.authorMcIntyre, James Aen_ZA
dc.contributor.authorHurter, Theunisen_ZA
dc.contributor.authorPeters, Remco P Hen_ZA
dc.date.accessioned2016-01-02T05:08:40Z
dc.date.available2016-01-02T05:08:40Z
dc.date.issued2015en_ZA
dc.description.abstractBACKGROUND: A pragmatic three-tiered approach to monitor the world's largest antiretroviral treatment (ART) programme was adopted by the South African National Department of Health in 2010. With the rapid expansion of the programme, the limitations of the paper-based register (tier 1) were the catalyst for implementation of the stand-alone electronic register (tier 2), which offers simple digitisation of the paper-based register. This article engages with theory on implementation to identify and contextualise enabling and constraining factors for implementation of the electronic register, to describe experiences and use of the register, and to make recommendations for implementation in similar settings where standardisation of ART monitoring and evaluation has not been achieved. METHODS: We conducted a qualitative evaluation of the roll-out of the register. This comprised twenty in-depth interviews with a diverse sample of stakeholders at facility, sub-district, and district levels of the health system. Facility-level participants were selected across five sub-districts, including one facility per sub-district. Responses were coded and analysed using a thematic approach. An implementation science framework guided interpretation of the data. Results & DISCUSSION: We identified the following seven themes: 1) ease of implementation, 2) perceived value of an electronic M&E system, 3) importance of stakeholder engagement, 4) influence of a data champion, 5) operational and logistical factors, 6) workload and role clarity, and 7) importance of integrating the electronic register with routine facility monitoring and evaluation. Interpreting our findings through an implementation theory enabled us to construct the scaffolding for implementation across the five facility-settings. This approach illustrated that implementation was not a linear process but occurred at two nodes: at the adoption of the register for roll-out, and at implementation at facility-level. CONCLUSION: In this study we found that relative advantage of an intervention and stakeholder engagement are critical to implementation. We suggest that without these aspects of implementation, formative and summative outcomes of implementation at both the adoption and coalface stages of implementation would be negatively affected.en_ZA
dc.identifier.apacitationMyburgh, H., Murphy, J. P., van Huyssteen, M., Foster, N., Grobbelaar, C. J., Struthers, H. E., ... Peters, R. P. H. (2015). Implementation of an electronic monitoring and evaluation system for the antiretroviral treatment programme in the Cape Winelands district, South Africa: a qualitative evaluation. <i>PLoS One</i>, http://hdl.handle.net/11427/16187en_ZA
dc.identifier.chicagocitationMyburgh, Hanlie, Joshua P Murphy, Mea van Huyssteen, Nicola Foster, Cornelius J Grobbelaar, Helen E Struthers, James A McIntyre, Theunis Hurter, and Remco P H Peters "Implementation of an electronic monitoring and evaluation system for the antiretroviral treatment programme in the Cape Winelands district, South Africa: a qualitative evaluation." <i>PLoS One</i> (2015) http://hdl.handle.net/11427/16187en_ZA
dc.identifier.citationMyburgh, H., Murphy, J. P., van Huyssteen, M., Foster, N., Grobbelaar, C. J., Struthers, H. E., ... & Peters, R. P. (2014). Implementation of an electronic monitoring and evaluation system for the antiretroviral treatment programme in the Cape Winelands district, South Africa: a qualitative evaluation. PloS one, 10(5), e0127223. doi:10.1371/journal.pone.0127223en_ZA
dc.identifier.ris TY - Journal Article AU - Myburgh, Hanlie AU - Murphy, Joshua P AU - van Huyssteen, Mea AU - Foster, Nicola AU - Grobbelaar, Cornelius J AU - Struthers, Helen E AU - McIntyre, James A AU - Hurter, Theunis AU - Peters, Remco P H AB - BACKGROUND: A pragmatic three-tiered approach to monitor the world's largest antiretroviral treatment (ART) programme was adopted by the South African National Department of Health in 2010. With the rapid expansion of the programme, the limitations of the paper-based register (tier 1) were the catalyst for implementation of the stand-alone electronic register (tier 2), which offers simple digitisation of the paper-based register. This article engages with theory on implementation to identify and contextualise enabling and constraining factors for implementation of the electronic register, to describe experiences and use of the register, and to make recommendations for implementation in similar settings where standardisation of ART monitoring and evaluation has not been achieved. METHODS: We conducted a qualitative evaluation of the roll-out of the register. This comprised twenty in-depth interviews with a diverse sample of stakeholders at facility, sub-district, and district levels of the health system. Facility-level participants were selected across five sub-districts, including one facility per sub-district. Responses were coded and analysed using a thematic approach. An implementation science framework guided interpretation of the data. Results & DISCUSSION: We identified the following seven themes: 1) ease of implementation, 2) perceived value of an electronic M&E system, 3) importance of stakeholder engagement, 4) influence of a data champion, 5) operational and logistical factors, 6) workload and role clarity, and 7) importance of integrating the electronic register with routine facility monitoring and evaluation. Interpreting our findings through an implementation theory enabled us to construct the scaffolding for implementation across the five facility-settings. This approach illustrated that implementation was not a linear process but occurred at two nodes: at the adoption of the register for roll-out, and at implementation at facility-level. CONCLUSION: In this study we found that relative advantage of an intervention and stakeholder engagement are critical to implementation. We suggest that without these aspects of implementation, formative and summative outcomes of implementation at both the adoption and coalface stages of implementation would be negatively affected. DA - 2015 DB - OpenUCT DO - 10.1371/journal.pone.0127223 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 T1 - Implementation of an electronic monitoring and evaluation system for the antiretroviral treatment programme in the Cape Winelands district, South Africa: a qualitative evaluation TI - Implementation of an electronic monitoring and evaluation system for the antiretroviral treatment programme in the Cape Winelands district, South Africa: a qualitative evaluation UR - http://hdl.handle.net/11427/16187 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/16187
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0127223
dc.identifier.vancouvercitationMyburgh H, Murphy JP, van Huyssteen M, Foster N, Grobbelaar CJ, Struthers HE, et al. Implementation of an electronic monitoring and evaluation system for the antiretroviral treatment programme in the Cape Winelands district, South Africa: a qualitative evaluation. PLoS One. 2015; http://hdl.handle.net/11427/16187.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_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.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2015 Myburgh et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherData managementen_ZA
dc.subject.otherNursesen_ZA
dc.subject.otherAntiretroviral therapyen_ZA
dc.subject.otherComputersen_ZA
dc.subject.otherRoutes of administrationen_ZA
dc.subject.otherAntiretroviralsen_ZA
dc.subject.otherLiteracyen_ZA
dc.subject.otherSouth Africaen_ZA
dc.titleImplementation of an electronic monitoring and evaluation system for the antiretroviral treatment programme in the Cape Winelands district, South Africa: a qualitative evaluationen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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