Top experts examine ARV access and health systems
Health-e
2008-07-28
South Africas top researchers, policy makers, managers and providers have released the outcome of a roundtable discussion held last year, where they grappled with antiretroviral access and the health systems capacity to cope with the increasing demand.
The report, authored by Helen Schneider, Dingie van
Rensburg and David Coetzee, contains the key findings and policy recommendations
fromt he meeting which they hope will feed into the country's National Strategic
Plan. Some of the main insights and messages that came out of the meeting were
that most of the existing programmes are still to a large extent doctor and
pharmacy dependent. Participants also felt strongly that integrating
antiretroviral therapy (ART) with HIV-related primary health care services
particularly with TB, the prevention of mother to child transmission and
maternal and child health services within a district health system remains
critical. The shortage, distribution, management and supervision of skilled
personnel in the public health sector posed serious impediments to efficient ART
provision and expansion, the participants said. There was also a strong feeling
that prevention efforts in particular the prevention of mother to child
transmission, have to be strengthened.
In summary, nine key overall lessons and recommendations
for policy arose from evidence presented at the Round Table:
- Recommendation 1: Shift the focus of ART implementation
from ART sites to district/subdistrict-based approaches.
- Recommendation 2: Mobilise and strengthen the existing
PHC system by reviewing the composition, staffing and support systems of PHC
teams.
- Recommendation 3: Integrate HIV and TB care, and provide
both as one service within PHC settings.
- Recommendation 4: Focus on PMTCT, and integrate the
programme into the treatment of children and pregnant women.
- Recommendation 5: Address loss to follow-up by
introducing services more widely spread across the system and by strengthening
systems for tracing dropouts.
- Recommendation 6: Build trust in the public health system
by seeing the system from the household and patients perspective so as to
better understand barriers to utilisation of services.
- Recommendation 7: Simplify and standardize approaches to
implementation for patients, programme governors and local providers to promote
better access and enhanced quality.
- Recommendation 8: Strengthen prevention and the health
system response to other diseases and build the PHC and district health system.
- Recommendation 9: Improve dialogue among researchers,
policy makers and service providers to promote the transfer of lessons, and to
harmonise and simplify approaches.
The full text of
"Health systems and antiretroviral access - key findings and policy
recommendations", a report on the Round-table Conference held on
22 and 23 October 2007 at the University of the
Free State
,
Bloemfontein
, compiled by Helen Schneider, Dingie van Rensburg and David Coetzee for the
Centre for Health Systems Research & Development is at:
http://www.health-e.org.za/documents/b54982c6503470fef44772016d1c83c6.pdf
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