Health system barriers to implementation of collaborative TB and HIV activities including prevention of mother to child transmission in South Africa

摘要

In South Africa, the control of TB and HIV co-infection remains a major challenge despite theavailability of international and national guidelines for integration of TB and HIV services. This studywas undertaken in KwaZulu-Natal, one of the provinces most affected by both TB and HIV, to identifyand understand managers’ and community care workers’ (CCWs) perceptions of health systems barriersrelated to the implementation of collaborative TB⁄ HIV activities, including prevention of mother tochild transmission of HIV (PMTCT). We conducted 29 in-depth interviews with health managers atprovincial, district and facility level and with managers of NGOs involved in TB and HIV care, as well assix focus group discussions with CCWs. Thematic analysis of transcripts revealed a convergence ofperspectives on the process and the level of the implementation of policy directives on collaborative TBand HIV activities across all categories of respondents (i.e. province-, district-, facility- and communitybasedorganizations). The majority of participants felt that the implementation of the policy wasinsufficiently consultative and that leadership and political will were lacking. The predominant themesrelated to health systems barriers include challenges related to structure and organisational culture;management, planning and power issues; unequal financing; and human resource capacity andregulatory problems notably relating to scope of practice of nurses and CCWs. Acceleratedimplementation of collaborative TB⁄ HIV activities including PMTCT will require political will andleadership to address these health systems barriers.