Implementation of an Electronic Monitoring and Evaluation System for the Antiretroviral Treatment Programme in the Cape Winelands District,South Africa: A Qualitative Evaluation |
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| Authors: | Hanlie Myburgh Joshua P Murphy Mea van Huyssteen Nicola Foster Cornelius J Grobbelaar Helen E Struthers James A McIntyre Theunis Hurter Remco P H Peters |
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| Institution: | 1Anova Health Institute, Paarl, Western Cape Province, South Africa;2Anova Health Institute, Johannesburg, Gauteng Province, South Africa;3School of Pharmacy, Faculty of Natural Science, University of the Western Cape, Bellville, Western Cape Province, South Africa;4School of Public Health and Family Medicine, University of Cape Town, Cape Town, Western Cape Province, South Africa;Örebro University, SWEDEN |
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| Abstract: | BackgroundA pragmatic three-tiered approach to monitor the world’s largest antiretroviral treatment (ART) programme was adopted by the South African National Department of Health in 2010. With the rapid expansion of the programme, the limitations of the paper-based register (tier 1) were the catalyst for implementation of the stand-alone electronic register (tier 2), which offers simple digitisation of the paper-based register. This article engages with theory on implementation to identify and contextualise enabling and constraining factors for implementation of the electronic register, to describe experiences and use of the register, and to make recommendations for implementation in similar settings where standardisation of ART monitoring and evaluation has not been achieved.MethodsWe conducted a qualitative evaluation of the roll-out of the register. This comprised twenty in-depth interviews with a diverse sample of stakeholders at facility, sub-district, and district levels of the health system. Facility-level participants were selected across five sub-districts, including one facility per sub-district. Responses were coded and analysed using a thematic approach. An implementation science framework guided interpretation of the data.ConclusionIn this study we found that relative advantage of an intervention and stakeholder engagement are critical to implementation. We suggest that without these aspects of implementation, formative and summative outcomes of implementation at both the adoption and coalface stages of implementation would be negatively affected. |
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