ABSTRACT
The formulation and approval of the Operational Plan for Comprehensive Care,
Management and Treatment for HIV/AIDS in 2003 was a major victory for the roll-out
of anti-retroviral therapy (ART) in the public sector in South Africa. Since its initiation in
2004, the ART Programme has expanded rapidly and realised considerable gains in
prolonging life. However, it has also faced major constraints and implementation has
been uneven across provinces. This study investigates the impact of organisational
capacity upon levels of adherence to ART in two public sector sites in Gauteng. The
study uses the Chronic Care Model (CCM) proposed by Edward Wagner (2004). The
CCM identifies four major components as crucial to effective clinical outcomes for the
management of chronic care. These factors are (1) prepared proactive practice teams; (2)
delivery systems design; (3) decision support; and (4) clinical information systems. Both
sites demonstrated different strengths and constraints. Strengths included the presence of
motivated champions leading the ART service, positive patient-provider relationships,
shifting of tasks to lower level health workers to deal with the shortage of skilled staff,
good relationships with non-governmental organisations and the innovation to deal with
challenges in a way that does not compromise the quality of care provided to patients
using the CCMT service. Overall constraints that were identified in the two facilities
include the shortage of skilled staff, burn-out among staff, a shortage of space,
inconsistent data collection and interpretation, as well as poor integration and
collaboration between local and provincial government in relation to the shared
responsibility for the provision of Tuberculosis (TB) treatment and other related CCMT
services. Despite these barriers, levels of adherence exceeded 85% in both sites.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/6030 |
| Date | 10 February 2009 |
| Creators | Pursell, Rebecca |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf, application/pdf, application/pdf |
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