Health systems strengthening

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As South Africa’s epidemic matures and government is instituting increasingly comprehensive forms of care, treatment and prevention, the national HIV response is moving away from crisis management towards ensuring healthcare in HIV is efficient, regulated, and of the highest possible quality.

Thus Anova’s initial focus on the provision of basic HIV care has gradually shifted to better align with PEPFAR’s long-term plan for supporting the South African government in its response to the epidemic. Anova has successfully moved away from direct support in many of the districts in which it works and now focuses on health systems strengthening.

As a result, Anova has increasingly concerned itself with finding enduring ways of bolstering the public health care system through skills-building, improved record-keeping and monitoring as well as renovating and upgrading facilities. By identifying opportunities to enhance public health, Anova is making significant contributions to the health care infrastructure in South Africa.

With the support of two new PEPFAR-funded grants, Anova’s future directions are continuing along the same trend. Support staff embedded in clinics have been absorbed by the health department as Anova continues to work towards health systems strengthening.

Anova’s work is achieved in partnership with the Department of Health and this relationship is integral to ensuring that its impact is lasting. Maintaining open channels of communication with local, provincial and national health departments means that Anova’s responses are based on communicated need, rather than perceived need. With insight into the roles and needs of health care workers and their patients and a deeper understanding of the challenges, the support Anova delivers is tailored and targeted.

Expanding ART services

The growing demand for HIV treatment requires that all primary health facilities offer ART. Because of the highly specialised and sensitive nature of HIV counselling, testing and treatment, this is no small feat. It requires skilled counsellors, clinicians and pharmacists as well as a reliable patient record keeping and referral system.

Anova’s project teams have responded by supporting the introduction of such services in clinics in their districts. This has entailed training staff as well as providing support staff and sometimes upgrading infrastructure.

In the Mopani district in Limpopo, ART services have been introduced to all Anova-supported sites. In the City of Johannesburg, Anova has helped introduce ART to 50 of the 54 clinics it supports in Regions D and G. This includes the newly refurbished Weilers Farm clinic, which now offers an ART service. This comes as a big relief to a community that previously needed to take two taxis to get to the nearest ART site at Lenasia South Community Health Centre.

Laying the foundations for good health

Some of Anova’s systems strengthening efforts have taken a more physical form through the upgrading of public health facilities.

Whilst training and technical support go a long way to ensuring quality care, often the success of treatment relies on a number of physical considerations. Doctors, nurses and counsellors require privacy and a designated space to work and see patients in, whilst effective dispensation of treatment relies on a well stocked, secure and controlled pharmacy.

Thus where there is a clear need for facility improvements or renovations at Anova-supported sites, Anova’s project teams attempt to meet that need, working with provincial and local health departments to ensure the upgrades meet everyone’s requirements.

Anova’s Bushbuckridge-based team upgraded two clinics in the sub-district coupling this with technical assistance and training to staff. The Marite and Cottondale clinics now offer fully-fledged ART programmes.

To help ease the impact of drug shortages, the Limpopo team also provides support on drug supply chain management to pharmacy staff.

TIER.Net – Tracking treatment

With close to six million South Africans living with HIV, keeping track of the epidemic is challenging. Not all clinics use the same monitoring and recording systems and a great deal of reporting is still paper-based. Yet having accurate data on illness and treatment is crucial to effectively responding to HIV.

This makes developing and implementing one universally applied digital system for keeping track of HIV patients a necessity in managing South Africa’s epidemic. Anova began responding to this need since its inception in 2009, and has made considerable headway in the rollout of a national monitoring and evaluation system.

Anova’s health system strengthening activities have also taken the form training and support for health care practitioners, particularly nurses.

Thus Anova’s project staff have trained nurses in Provider Initiated Counselling and Testing (PICT), Nurse Initiated Management of Antiretroviral Treatment (NIMART) as well as pharmacovigilance.

Anova’s strategic support also takes the shape of fostering productive partnerships and lending expertise to government where needed.

In Gauteng, Anova played a key role in facilitating communication and building rapport between the City of Johannesburg, NGOs and the Department of Health. The signing of a new Memorandum of Agreement in 2012 bares testimony to a continued healthy relationship between the city, civil society and the health department.

In December 2011 the Department of Health released a new National Strategic Plan on HIV, STIs and TB for 2012 to 2016. Anova provided strategic input during the development of the plan and subsequently contributed to the drafting of provincial strategic plans for Gauteng and Mpumalanga.

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