Differences in antiretroviral scale up in three South African provinces: the role of implementation management
Differences in antiretroviral scale up in three South African provinces: the role of implementation management
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DOI：
10.1186/1472-6963-10-s1-s4
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发表时间：
2010-07-02
影响因子：
2.8
通讯作者：
Gilson, Lucy
中科院分区：
文献类型：
--
作者：
Schneider, Helen;Coetzee, David;Gilson, Lucy
背景资料：南非的抗逆转录病毒方案由明确的国家计划管理，确定治疗目标，并通过限定条件的赠款提供资金。然而，根据该国的准联邦宪法，省政府承担提供保健的主要责任，并拥有一定程度的自主权，因此可以选择如何执行其艾滋病毒/艾滋病方案。本文是对南非三个省政府（西开普省，豪登和自由邦-侧重于业务和战略两个方面。根据2005年至2007年在三个省进行的抗逆转录病毒疗法护理模式调查和政策进程分析，以及关于在南非扩大抗逆转录病毒疗法的大量灰色和索引文献，它将实施进程与各省抗逆转录病毒疗法覆盖率的差异联系起来三个省的平均水平（低、中、高）。虽然各省采取了类似的慢性病护理办法，但在方案的政治和管理领导、方案设计中央标准化和地方灵活性之间的平衡，监测和评价系统的有效性，外部支持和方案partnerships.Conclusions的性质和程度：本案例研究指出了次国家方案进程的重要性和影响因素以外的融资或人力资源能力，在理解干预规模扩大。
Background: South Africa's antiretroviral programme is governed by defined national plans, establishing treatment targets and providing funding through ring-fenced conditional grants. However, in terms of the country's quasi-federal constitution, provincial governments bear the main responsibility for provision of health care, and have a certain amount of autonomy and therefore choice in the way their HIV/AIDS programmes are implemented.Methods: The paper is a comparative case study of the early management of ART scale up in three South African provincial governments - Western Cape, Gauteng and Free State - focusing on both operational and strategic dimensions. Drawing on surveys of models of ART care and analyses of the policy process conducted in the three provinces between 2005 and 2007, as well as a considerable body of grey and indexed literature on ART scale up in South Africa, it draws links between implementation processes and variations in provincial ART coverage (low, medium and high) achieved in the three provinces.Results: While they adopted similar chronic disease care approaches, the provinces differed with respect to political and managerial leadership of the programme, programme design, the balance between central standardisation and local flexibility, the effectiveness of monitoring and evaluation systems, and the nature and extent of external support and programme partnerships.Conclusions: This case study points to the importance of sub-national programme processes and the influence of factors other than financing or human resource capacity, in understanding intervention scale up.