School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown 2193, South Africa.
Health Res Policy Syst. 2012 Jan 26;10:2. doi: 10.1186/1478-4505-10-2.
Like many low- and middle-income countries, South Africa established a dedicated HIV monitoring and evaluation (M&E) system to track the national response to HIV/AIDS. Its implementation in the public health sector has however not been assessed. Since responsibility for health services management lies at the district (sub-national) level, this study aimed to assess the extent to which the HIV M&E system is integrated with the overall health system M&E function at district level. This study describes implementation of the HIV M&E system, determines the extent to which it is integrated with the district health information system (DHIS), and evaluates factors influencing HIV M&E integration.
The study was conducted in one health district in South Africa. Data were collected through key informant interviews with programme and health facility managers and review of M&E records at health facilities providing HIV services. Data analysis assessed the extent to which processes for HIV data collection, collation, analysis and reporting were integrated with the DHIS.
The HIV M&E system is top-down, over-sized, and captures a significant amount of energy and resources to primarily generate antiretroviral treatment (ART) indicators. Processes for producing HIV prevention indicators are integrated with the DHIS. However processes for the production of HIV treatment indicators by-pass the DHIS and ART indicators are not disseminated to district health managers. Specific reporting requirements linked to ear-marked funding, politically-driven imperatives, and mistrust of DHIS capacity are key drivers of this silo approach.
Parallel systems that bypass the DHIS represent a missed opportunity to strengthen system-wide M&E capacity. Integrating HIV M&E (staff, systems and process) into the health system M&E function would mobilise ear-marked HIV funding towards improving DHIS capacity to produce quality and timely HIV indicators that would benefit both programme and health system M&E functions. This offers a practical way of maximising programme-system synergies and translating the health system strengthening intents of existing HIV policies into tangible action.
与许多中低收入国家一样，南非建立了专门的艾滋病毒监测和评估 (M&E) 系统，以跟踪国家对艾滋病毒/艾滋病的应对情况。然而，其在公共卫生部门的实施情况尚未得到评估。由于卫生服务管理的责任在于地区（国家以下一级），因此，本研究旨在评估艾滋病毒监测和评估系统在多大程度上与地区一级的整体卫生系统监测和评估功能相整合。本研究描述了艾滋病毒监测和评估系统的实施情况，确定了其与地区卫生信息系统 (DHIS) 的整合程度，并评估了影响艾滋病毒监测和评估整合的因素。
本研究在南非的一个卫生区进行。通过对方案和卫生机构管理人员进行关键人员访谈，并对提供艾滋病毒服务的卫生机构的监测和评估记录进行审查，收集了数据。数据分析评估了艾滋病毒数据收集、整理、分析和报告过程与 DHIS 整合的程度。
艾滋病毒监测和评估系统是自上而下的，规模过大，消耗了大量的精力和资源，主要是为了产生抗逆转录病毒治疗 (ART) 指标。产生艾滋病毒预防指标的过程与 DHIS 整合。然而，产生艾滋病毒治疗指标的过程绕过了 DHIS，ART 指标也没有传播给地区卫生管理人员。与专用资金、政治驱动的命令和对 DHIS 能力的不信任相关的具体报告要求是这种筒仓方法的关键驱动因素。
绕过 DHIS 的并行系统代表了加强全系统监测和评估能力的错失机会。将艾滋病毒监测和评估（人员、系统和流程）整合到卫生系统监测和评估功能中，可以将专用艾滋病毒资金用于加强 DHIS 能力，以生成高质量和及时的艾滋病毒指标，从而使方案和卫生系统监测和评估功能都受益。这为最大限度地发挥方案-系统协同作用，将现有艾滋病毒政策的卫生系统加强意图转化为切实行动提供了一种实用方法。
