Jeannine Uwimana - Academia.edu (original) (raw)
Papers by Jeannine Uwimana
University of the Western Cape, 2012
Studies in health technology and informatics
Evaluations that have looked at the people aspect of the health information system in South Afric... more Evaluations that have looked at the people aspect of the health information system in South Africa have only focused on the availability of human resources and not on competence or other behavioural factors. Using the Performance of Routine Information System Management (PRISM) tool that assumes relationships between technical, behavioural and organizational determinants of the routine information processes and performance, this paper highlights some behavioural factors affecting the quality of routinely collected data in South Africa. In the context of monitoring maternal and child health programmes, data were collected from 161 health information personnel in 58 health facilities and 2 district offices from 2 conveniently sampled health districts. A self-administered questionnaire was used to assess confidence and competence levels of routine health information system (RHIS) tasks, problem solving anddata quality checking skills, and motivation. The findings suggest that 64% of th...
The International Journal of Tuberculosis and Lung Disease, 2013
To conduct an impact assessment of an intervention to enhance the provision of community-based in... more To conduct an impact assessment of an intervention to enhance the provision of community-based integrated services for tuberculosis (TB), human immunodeficiency virus (HIV) and prevention of mother-to-child transmission (PMTCT). M E T H O D S : The intervention consisted of a combination of training of community care workers (CCWs), structural adjustments, harmonisation of scope of practice and stipend of CCWs and enhanced supervision of CCWs to provide comprehensive TB-HIV/PMTCT services in a rural South African district. A before and after study design was used with a household survey to assess the operational effectiveness of the intervention. Six clusters were randomised into intervention and control arms. Quantitative data were analysed using logistic regression, adjusting for cluster design. R E S U LT S : Logistic regression analyses of the survey data show that CCWs from the intervention arm performed better in the provision of TB-HIV/PMTCT services, such as screening for TB and sexually transmitted infections, adherence to anti-tuberculosis treatment and antiretroviral therapy and counselling on infant feeding compared to the control CCWs (P < 0.05). However, intervention CCWs performed worse in the integrated management of childhood illnesses education and social welfare referrals (P < 0.05). The uptake of HIV testing increased significantly in the intervention arm, from 55% to 78% (P < 0.001). C O N C L U S I O N : The intervention was effective in enhancing the provision of community-based TB-HIV and PMTCT services. However, attention to other primary health care services is required to ensure that all key services are provided.
The abstract has the methods section and the word limit is <350(330).
I declare that "Community participation in collaborative tuberculosis and HIV activities includin... more I declare that "Community participation in collaborative tuberculosis and HIV activities including prevention of mother-to-child transmission (PMTCT): development and evaluation of an intervention to enhance integration of TB/HIV/PMTCT services in a rural area of South Africa" is my own work, that it has not been submitted before for any degree or examination at any other university, and that all the sources I have used or quoted have been indicated and acknowledged as complete references. This thesis is written in monograph format with Chapter 4 Results written in the form of five manuscripts which have either been published or submitted for publication. This serves to confirm that I am listed in all the manuscripts as the first author and my supervisors were co-authors. Below is the list of the papers: Paper I Uwimana J, Jackson D and Zarowsky C (2012). Health care providers' and patients' perspectives on provision of TB/ HIV services including prevention of mother-to-child transmission (PMTCT) in a rural district, South Africa.
PLOS ONE
Background The World Health Organization recommends isoniazid preventive therapy (IPT) for six mo... more Background The World Health Organization recommends isoniazid preventive therapy (IPT) for six months for child contacts without tuberculosis (TB), who are exposed to an adult with active TB. The effectiveness of IPT depends on 80% or greater adherence to medication. In the current study, we assessed IPT adherence and explored barriers to and facilitators of adherence among eligible child contacts in Kigali, Rwanda.
Tuberculosis research and treatment, 2018
To assess the uptake of isoniazid preventive therapy (IPT) by eligible children in Kigali, Rwanda... more To assess the uptake of isoniazid preventive therapy (IPT) by eligible children in Kigali, Rwanda, and associated individual, households, and healthcare systems characteristics. A cross-sectional study was conducted among child contacts of index cases having sputum smear-positive pulmonary tuberculosis. Data were collected from 13 selected primary health centres. Descriptive statistics were used to generate frequency tables and figures. Logistic regression models were performed to determine characteristics associated with IPT uptake. Of 270 children (under 15 years), who were household contacts of 136 index cases, 94 (35%) children were less than 5 years old and eligible for IPT; and 84 (89%, 95% CI 81-94) were initiated on IPT. The reasons for not initiating IPT in the remaining 10 children were parents/caregivers' lack of information on the need for IPT, refusal to give IPT to their children, and poor quality services offered at health centres. Factors associated with no uptak...
The Pan African medical journal, 2018
To report on the diagnostic yield using the Xpert MTB/RIF assay on gastric lavage samples from ch... more To report on the diagnostic yield using the Xpert MTB/RIF assay on gastric lavage samples from children (<15 years) who were household contacts of tuberculosis (TB) cases in Kigali, Rwanda. A cross-sectional study was conducted among 216 child contacts of index cases with sputum smear-positive TB over a 7 month period, from 1 August 2015 to 29 February 2016. Child contacts with tuberculosis-related symptoms or abnormal chest X-ray had sputum collected by gastric lavage on two consecutive days and samples were examined by smear microscopy, Xpert MTB/RIF assay and solid culture. Of the 216 child contacts, 94 (44%) were less than 5 years of age. Most of them 84 (89%) were receiving isoniazid preventive therapy at the time of screening. Thirty seven out of 216 children had TB-related symptoms. Only 4 (10.8%) were clinically diagnosed with TB; and none had bacteriologically confirmed tuberculosis. The use of Xpert MTB/RIF assay did not contribute to bacteriological confirmation of act...
SAHARA-J: Journal of Social Aspects of HIV/AIDS, 2007
The rising number of people living with HIV/AIDS (PLWHA) worldwide has made health care professio... more The rising number of people living with HIV/AIDS (PLWHA) worldwide has made health care professionals and policy makers search for accessible health care that will meet the needs of people who are suffering from the disease and enhance their quality of life (QoL).This study investigated met and unmet palliative care needs of PLWHA in selected areas in Rwanda.The study sample included 306 participants: PLWHA, health care professionals and coordinators of HIV/AIDS units. Quantitative and qualitative methodologies were used.The data were analysed separately and then triangulated. In the findings, over 50% of PLWHA had symptoms related to HIV/AIDS most of the time, with the most common symptom being pain. Participation in activities of daily living was significantly associated with the health status of PLWHA (p<0.001).The most common perceived palliative care needs of PLWHA were medical needs, psychosocial needs and the need for financial assistance (77%); home-based care (47%); nutritional support (44%); and pain relief and management of other symptoms (43%). Most PLWHA indicated these palliative care needs were unmet, in particular the need for pain relief, symptom management, financial assistance and nutritional support. Over 50% of health care professionals reported they were not trained in palliative care.They indicated that inadequate policy and resources were the main obstacles to the provision of optimal palliative care. Addressing unmet palliative care needs would enhance the QoL of PLWHA. In addition, developing policy related to the provision of palliative care and building the capacity of health care providers is essential for the provision of adequate palliative care services in Rwanda.
Progress in Palliative Care, 2008
ABSTRACT The main aim of palliative care is to improve the quality of life of people facing threa... more ABSTRACT The main aim of palliative care is to improve the quality of life of people facing threatening diseases by allowing them a dignified death. Therefore, it is crucial to take into account the user's preference of where to be taken care of during the terminal phase of illness. Palliative care in Rwanda is at an early phase of development; therefore, effective planning and implementation that considers the user's view on where to be taken care of is important. This study investigated where HIV/AIDS patients wanted to be cared for in the terminal phase of illness. The results form part of a larger study on met and unmet palliative care needs of people living with HIV/AIDS in selected areas in Rwanda.
Progress in Palliative Care, 2008
Tropical Medicine & International Health, 2012
In South Africa, the control of TB and HIV co-infection remains a major challenge despite the ava... more In South Africa, the control of TB and HIV co-infection remains a major challenge despite the availability of international and national guidelines for integration of TB and HIV services. This study was undertaken in KwaZulu-Natal, one of the provinces most affected by both TB and HIV, to identify and understand managers' and community care workers' (CCWs) perceptions of health systems barriers related to the implementation of collaborative TB/HIV activities, including prevention of mother to child transmission of HIV (PMTCT). We conducted 29 in-depth interviews with health managers at provincial, district and facility level and with managers of NGOs involved in TB and HIV care, as well as six focus group discussions with CCWs. Thematic analysis of transcripts revealed a convergence of perspectives on the process and the level of the implementation of policy directives on collaborative TB and HIV activities across all categories of respondents (i.e. province-, district-, facility-and community-based organizations). The majority of participants felt that the implementation of the policy was insufficiently consultative and that leadership and political will were lacking. The predominant themes related to health systems barriers include challenges related to structure and organisational culture; management, planning and power issues; unequal financing; and human resource capacity and regulatory problems notably relating to scope of practice of nurses and CCWs. Accelerated implementation of collaborative TB/HIV activities including PMTCT will require political will and leadership to address these health systems barriers.
Tropical Medicine & International Health, 2012
To describe a participatory approach to implement and evaluate ways to integrate and train commun... more To describe a participatory approach to implement and evaluate ways to integrate and train community care workers (CCWs) to enhance collaborative TB/HIV/PMTCT activities, and home-based HIV counseling and testing (HCT) at community level. The intervention study was conducted in Sisonke, a rural district of KwaZulu Natal, South Africa. A baseline household (HH) survey was conducted in 11 villages. Six villages were randomly selected into intervention and control clusters. Training was provided first to CCWs from the intervention cluster (IC) followed by the control cluster (CC). Routine monthly data from CCWs were collected from March-December 2010. The data was subjected to bivariate tests. The baseline HH survey revealed that of 3012 HH members visited by CCWs in 2008, 21% were screened for TB symptoms, 7% were visited for TB adherence support and 2% for ART adherence, and 1.5% were counselled on infant feeding options. A total of 89 CCWs were trained. Data show that during the study period in IC, 684 adults were offered HCT by CCWs, 92% accepted HCT and tested and 7% tested HIV-positive and were referred to the clinic for further care. Of 3556 adults served in IC, 44% were screened for TB symptoms and 32% for symptoms of sexually transmitted infections (STIs) and 37% of children were traced as TB contact. Out of 6226 adults served in CC, 10% were screened for TB symptoms and 7% for STI symptoms. The differences in uptake of services between IC and CC were statistically significant (p<0.05). The findings of this study suggest higher uptake of TB and STI symptoms screening, TB contact tracing and home based HCT in the intervention clusters. This study suggests that up-skilling CCWs could be one avenue to enhance TB/HIV case finding, TB contact tracing and linkages to care.
BMC Health Services Research, 2012
Background: The implementation of collaborative TB/HIV activities may help to mitigate the impact... more Background: The implementation of collaborative TB/HIV activities may help to mitigate the impact of the dual epidemic on patients and communities. Such implementation requires integrated interventions across facilities and levels of government, and with communities. Engaging Community Care Workers (CCWs) in the delivery of integrated TB/HIV services may enhance universal coverage and treatment outcomes, and address human resource needs in sub-Saharan Africa. Methods: Using pre-intervention research in Sisonke district, KwaZulu-Natal, South Africa as a case study, we report on three study objectives: (1) to determine the extent of the engagement of NGOs and CCWs in the implementation of collaborative TB/HIV including PMTCT; (2) to identify constraints related to provision of TB/HIV/ PMTCT integrated care at community level; and (3) to explore ways of enhancing the engagement of CCWs to provide integrated TB/HIV/PMTCT services. Our mixed method study included facility and NGO audits, a household survey (n = 3867), 33 key informant interviews with provincial, district, facility, and NGO managers, and six CCW and patient focus group discussions. Results: Most contracted NGOs were providing TB or HIV support and care with little support for PMTCT. Only 11% of facilities' TB and HIV patients needing care and support at the community level were receiving support from CCWs. Only 2% of pregnant women reported being counseled by CCWs on infant feeding options and HIV testing. Most facilities (83%) did not have any structural linkage with NGOs. Major constraints identified were system-related: structural, organizational and managerial constraints; inadequate CCW training and supervision; limited scope of CCW practice; inadequate funding; and inconsistency in supplies and equipment. Individual and community factors, such as lack of disclosure, stigma related to HIV, and cultural beliefs were also identified as constraints. Conclusions: NGO/CCW engagement in the implementation of collaborative TB/HIV/PMTCT activities is sub-optimal, despite its potential benefits. Effective interventions that address contextual and health systems challenges are required. These should combine systematic skills-building, an enhanced scope of practice and consistent CCW supervision with a reliable referral and monitoring and evaluation system.
Evaluations that have looked at the people aspect of the health information system in South Afric... more Evaluations that have looked at the people aspect of the health information system in South Africa have only focused on the availability of human resources and not on competence or other behavioural factors. Using the Performance of Routine Information System Management (PRISM) tool that assumes relationships between technical, behavioural and organizational determinants of the routine information processes and performance, this paper highlights some behavioural factors affecting the quality of routinely collected data in South Africa. In the context of monitoring maternal and child health programmes , data were collected from 161 health information personnel in 58 health facilities and 2 district offices from 2 conveniently sampled health districts. A self-administered questionnaire was used to assess confidence and competence levels of routine health information system (RHIS) tasks, problem solving and data quality checking skills, and motivation. The findings suggest that 64% of the respondents have poor numerical skills and limited statistical and data quality checking skills. While the average confidence levels at performing RHIS tasks is 69%, only 22% actually displayed competence above 50%. Personnel appear to be reasonably motivated but there is considerable deficiency in their competency to interpret and use data. This may undermine the quality and utility of the RHIS.
University of the Western Cape, 2012
Studies in health technology and informatics
Evaluations that have looked at the people aspect of the health information system in South Afric... more Evaluations that have looked at the people aspect of the health information system in South Africa have only focused on the availability of human resources and not on competence or other behavioural factors. Using the Performance of Routine Information System Management (PRISM) tool that assumes relationships between technical, behavioural and organizational determinants of the routine information processes and performance, this paper highlights some behavioural factors affecting the quality of routinely collected data in South Africa. In the context of monitoring maternal and child health programmes, data were collected from 161 health information personnel in 58 health facilities and 2 district offices from 2 conveniently sampled health districts. A self-administered questionnaire was used to assess confidence and competence levels of routine health information system (RHIS) tasks, problem solving anddata quality checking skills, and motivation. The findings suggest that 64% of th...
The International Journal of Tuberculosis and Lung Disease, 2013
To conduct an impact assessment of an intervention to enhance the provision of community-based in... more To conduct an impact assessment of an intervention to enhance the provision of community-based integrated services for tuberculosis (TB), human immunodeficiency virus (HIV) and prevention of mother-to-child transmission (PMTCT). M E T H O D S : The intervention consisted of a combination of training of community care workers (CCWs), structural adjustments, harmonisation of scope of practice and stipend of CCWs and enhanced supervision of CCWs to provide comprehensive TB-HIV/PMTCT services in a rural South African district. A before and after study design was used with a household survey to assess the operational effectiveness of the intervention. Six clusters were randomised into intervention and control arms. Quantitative data were analysed using logistic regression, adjusting for cluster design. R E S U LT S : Logistic regression analyses of the survey data show that CCWs from the intervention arm performed better in the provision of TB-HIV/PMTCT services, such as screening for TB and sexually transmitted infections, adherence to anti-tuberculosis treatment and antiretroviral therapy and counselling on infant feeding compared to the control CCWs (P < 0.05). However, intervention CCWs performed worse in the integrated management of childhood illnesses education and social welfare referrals (P < 0.05). The uptake of HIV testing increased significantly in the intervention arm, from 55% to 78% (P < 0.001). C O N C L U S I O N : The intervention was effective in enhancing the provision of community-based TB-HIV and PMTCT services. However, attention to other primary health care services is required to ensure that all key services are provided.
The abstract has the methods section and the word limit is <350(330).
I declare that "Community participation in collaborative tuberculosis and HIV activities includin... more I declare that "Community participation in collaborative tuberculosis and HIV activities including prevention of mother-to-child transmission (PMTCT): development and evaluation of an intervention to enhance integration of TB/HIV/PMTCT services in a rural area of South Africa" is my own work, that it has not been submitted before for any degree or examination at any other university, and that all the sources I have used or quoted have been indicated and acknowledged as complete references. This thesis is written in monograph format with Chapter 4 Results written in the form of five manuscripts which have either been published or submitted for publication. This serves to confirm that I am listed in all the manuscripts as the first author and my supervisors were co-authors. Below is the list of the papers: Paper I Uwimana J, Jackson D and Zarowsky C (2012). Health care providers' and patients' perspectives on provision of TB/ HIV services including prevention of mother-to-child transmission (PMTCT) in a rural district, South Africa.
PLOS ONE
Background The World Health Organization recommends isoniazid preventive therapy (IPT) for six mo... more Background The World Health Organization recommends isoniazid preventive therapy (IPT) for six months for child contacts without tuberculosis (TB), who are exposed to an adult with active TB. The effectiveness of IPT depends on 80% or greater adherence to medication. In the current study, we assessed IPT adherence and explored barriers to and facilitators of adherence among eligible child contacts in Kigali, Rwanda.
Tuberculosis research and treatment, 2018
To assess the uptake of isoniazid preventive therapy (IPT) by eligible children in Kigali, Rwanda... more To assess the uptake of isoniazid preventive therapy (IPT) by eligible children in Kigali, Rwanda, and associated individual, households, and healthcare systems characteristics. A cross-sectional study was conducted among child contacts of index cases having sputum smear-positive pulmonary tuberculosis. Data were collected from 13 selected primary health centres. Descriptive statistics were used to generate frequency tables and figures. Logistic regression models were performed to determine characteristics associated with IPT uptake. Of 270 children (under 15 years), who were household contacts of 136 index cases, 94 (35%) children were less than 5 years old and eligible for IPT; and 84 (89%, 95% CI 81-94) were initiated on IPT. The reasons for not initiating IPT in the remaining 10 children were parents/caregivers' lack of information on the need for IPT, refusal to give IPT to their children, and poor quality services offered at health centres. Factors associated with no uptak...
The Pan African medical journal, 2018
To report on the diagnostic yield using the Xpert MTB/RIF assay on gastric lavage samples from ch... more To report on the diagnostic yield using the Xpert MTB/RIF assay on gastric lavage samples from children (<15 years) who were household contacts of tuberculosis (TB) cases in Kigali, Rwanda. A cross-sectional study was conducted among 216 child contacts of index cases with sputum smear-positive TB over a 7 month period, from 1 August 2015 to 29 February 2016. Child contacts with tuberculosis-related symptoms or abnormal chest X-ray had sputum collected by gastric lavage on two consecutive days and samples were examined by smear microscopy, Xpert MTB/RIF assay and solid culture. Of the 216 child contacts, 94 (44%) were less than 5 years of age. Most of them 84 (89%) were receiving isoniazid preventive therapy at the time of screening. Thirty seven out of 216 children had TB-related symptoms. Only 4 (10.8%) were clinically diagnosed with TB; and none had bacteriologically confirmed tuberculosis. The use of Xpert MTB/RIF assay did not contribute to bacteriological confirmation of act...
SAHARA-J: Journal of Social Aspects of HIV/AIDS, 2007
The rising number of people living with HIV/AIDS (PLWHA) worldwide has made health care professio... more The rising number of people living with HIV/AIDS (PLWHA) worldwide has made health care professionals and policy makers search for accessible health care that will meet the needs of people who are suffering from the disease and enhance their quality of life (QoL).This study investigated met and unmet palliative care needs of PLWHA in selected areas in Rwanda.The study sample included 306 participants: PLWHA, health care professionals and coordinators of HIV/AIDS units. Quantitative and qualitative methodologies were used.The data were analysed separately and then triangulated. In the findings, over 50% of PLWHA had symptoms related to HIV/AIDS most of the time, with the most common symptom being pain. Participation in activities of daily living was significantly associated with the health status of PLWHA (p<0.001).The most common perceived palliative care needs of PLWHA were medical needs, psychosocial needs and the need for financial assistance (77%); home-based care (47%); nutritional support (44%); and pain relief and management of other symptoms (43%). Most PLWHA indicated these palliative care needs were unmet, in particular the need for pain relief, symptom management, financial assistance and nutritional support. Over 50% of health care professionals reported they were not trained in palliative care.They indicated that inadequate policy and resources were the main obstacles to the provision of optimal palliative care. Addressing unmet palliative care needs would enhance the QoL of PLWHA. In addition, developing policy related to the provision of palliative care and building the capacity of health care providers is essential for the provision of adequate palliative care services in Rwanda.
Progress in Palliative Care, 2008
ABSTRACT The main aim of palliative care is to improve the quality of life of people facing threa... more ABSTRACT The main aim of palliative care is to improve the quality of life of people facing threatening diseases by allowing them a dignified death. Therefore, it is crucial to take into account the user's preference of where to be taken care of during the terminal phase of illness. Palliative care in Rwanda is at an early phase of development; therefore, effective planning and implementation that considers the user's view on where to be taken care of is important. This study investigated where HIV/AIDS patients wanted to be cared for in the terminal phase of illness. The results form part of a larger study on met and unmet palliative care needs of people living with HIV/AIDS in selected areas in Rwanda.
Progress in Palliative Care, 2008
Tropical Medicine & International Health, 2012
In South Africa, the control of TB and HIV co-infection remains a major challenge despite the ava... more In South Africa, the control of TB and HIV co-infection remains a major challenge despite the availability of international and national guidelines for integration of TB and HIV services. This study was undertaken in KwaZulu-Natal, one of the provinces most affected by both TB and HIV, to identify and understand managers' and community care workers' (CCWs) perceptions of health systems barriers related to the implementation of collaborative TB/HIV activities, including prevention of mother to child transmission of HIV (PMTCT). We conducted 29 in-depth interviews with health managers at provincial, district and facility level and with managers of NGOs involved in TB and HIV care, as well as six focus group discussions with CCWs. Thematic analysis of transcripts revealed a convergence of perspectives on the process and the level of the implementation of policy directives on collaborative TB and HIV activities across all categories of respondents (i.e. province-, district-, facility-and community-based organizations). The majority of participants felt that the implementation of the policy was insufficiently consultative and that leadership and political will were lacking. The predominant themes related to health systems barriers include challenges related to structure and organisational culture; management, planning and power issues; unequal financing; and human resource capacity and regulatory problems notably relating to scope of practice of nurses and CCWs. Accelerated implementation of collaborative TB/HIV activities including PMTCT will require political will and leadership to address these health systems barriers.
Tropical Medicine & International Health, 2012
To describe a participatory approach to implement and evaluate ways to integrate and train commun... more To describe a participatory approach to implement and evaluate ways to integrate and train community care workers (CCWs) to enhance collaborative TB/HIV/PMTCT activities, and home-based HIV counseling and testing (HCT) at community level. The intervention study was conducted in Sisonke, a rural district of KwaZulu Natal, South Africa. A baseline household (HH) survey was conducted in 11 villages. Six villages were randomly selected into intervention and control clusters. Training was provided first to CCWs from the intervention cluster (IC) followed by the control cluster (CC). Routine monthly data from CCWs were collected from March-December 2010. The data was subjected to bivariate tests. The baseline HH survey revealed that of 3012 HH members visited by CCWs in 2008, 21% were screened for TB symptoms, 7% were visited for TB adherence support and 2% for ART adherence, and 1.5% were counselled on infant feeding options. A total of 89 CCWs were trained. Data show that during the study period in IC, 684 adults were offered HCT by CCWs, 92% accepted HCT and tested and 7% tested HIV-positive and were referred to the clinic for further care. Of 3556 adults served in IC, 44% were screened for TB symptoms and 32% for symptoms of sexually transmitted infections (STIs) and 37% of children were traced as TB contact. Out of 6226 adults served in CC, 10% were screened for TB symptoms and 7% for STI symptoms. The differences in uptake of services between IC and CC were statistically significant (p<0.05). The findings of this study suggest higher uptake of TB and STI symptoms screening, TB contact tracing and home based HCT in the intervention clusters. This study suggests that up-skilling CCWs could be one avenue to enhance TB/HIV case finding, TB contact tracing and linkages to care.
BMC Health Services Research, 2012
Background: The implementation of collaborative TB/HIV activities may help to mitigate the impact... more Background: The implementation of collaborative TB/HIV activities may help to mitigate the impact of the dual epidemic on patients and communities. Such implementation requires integrated interventions across facilities and levels of government, and with communities. Engaging Community Care Workers (CCWs) in the delivery of integrated TB/HIV services may enhance universal coverage and treatment outcomes, and address human resource needs in sub-Saharan Africa. Methods: Using pre-intervention research in Sisonke district, KwaZulu-Natal, South Africa as a case study, we report on three study objectives: (1) to determine the extent of the engagement of NGOs and CCWs in the implementation of collaborative TB/HIV including PMTCT; (2) to identify constraints related to provision of TB/HIV/ PMTCT integrated care at community level; and (3) to explore ways of enhancing the engagement of CCWs to provide integrated TB/HIV/PMTCT services. Our mixed method study included facility and NGO audits, a household survey (n = 3867), 33 key informant interviews with provincial, district, facility, and NGO managers, and six CCW and patient focus group discussions. Results: Most contracted NGOs were providing TB or HIV support and care with little support for PMTCT. Only 11% of facilities' TB and HIV patients needing care and support at the community level were receiving support from CCWs. Only 2% of pregnant women reported being counseled by CCWs on infant feeding options and HIV testing. Most facilities (83%) did not have any structural linkage with NGOs. Major constraints identified were system-related: structural, organizational and managerial constraints; inadequate CCW training and supervision; limited scope of CCW practice; inadequate funding; and inconsistency in supplies and equipment. Individual and community factors, such as lack of disclosure, stigma related to HIV, and cultural beliefs were also identified as constraints. Conclusions: NGO/CCW engagement in the implementation of collaborative TB/HIV/PMTCT activities is sub-optimal, despite its potential benefits. Effective interventions that address contextual and health systems challenges are required. These should combine systematic skills-building, an enhanced scope of practice and consistent CCW supervision with a reliable referral and monitoring and evaluation system.
Evaluations that have looked at the people aspect of the health information system in South Afric... more Evaluations that have looked at the people aspect of the health information system in South Africa have only focused on the availability of human resources and not on competence or other behavioural factors. Using the Performance of Routine Information System Management (PRISM) tool that assumes relationships between technical, behavioural and organizational determinants of the routine information processes and performance, this paper highlights some behavioural factors affecting the quality of routinely collected data in South Africa. In the context of monitoring maternal and child health programmes , data were collected from 161 health information personnel in 58 health facilities and 2 district offices from 2 conveniently sampled health districts. A self-administered questionnaire was used to assess confidence and competence levels of routine health information system (RHIS) tasks, problem solving and data quality checking skills, and motivation. The findings suggest that 64% of the respondents have poor numerical skills and limited statistical and data quality checking skills. While the average confidence levels at performing RHIS tasks is 69%, only 22% actually displayed competence above 50%. Personnel appear to be reasonably motivated but there is considerable deficiency in their competency to interpret and use data. This may undermine the quality and utility of the RHIS.