Transition to an in-facility electronic Tuberculosis register: Lessons from a South African pilot project

• Main Authors: Hanlie Myburgh, Remco P.H. Peters, Theunis Hurter, Cornelius J. Grobbelaar, Graeme Hoddinott
• Format: Article
• Language: English
• Published: AOSIS 2020-01-01
• Series: Southern African Journal of HIV Medicine
• Subjects: tb programme; systems integration; monitoring and evaluation; roles and responsibilities; hiv
• Online Access: https://sajhivmed.org.za/index.php/hivmed/article/view/1025

Background: South Africa has one of the highest incidences of Tuberculosis (TB) globally. High co-morbid HIV prevalence complicates TB management and treatment outcomes. Growing evidence suggests that integrating the TB and HIV programmes will improve the overall results. Objectives: To describe how TB programme staff at various levels of the South African health system responded to the transition from a paper-based to an electronic register of TB data integrated with HIV programme data. Method: Three primary health service facilities in the Cape Winelands district, Western Cape province, South Africa served as pilot sites for implementation. Semi-structured interviews were conducted with 21 TB programme staff purposively selected at facility, sub-district, district and provincial levels of the health system, based on their involvement in implementing electronic TB data. An objective-driven thematic frame was used to analyse the data. Results: Fears about the transition included reductions in data quality, changes to the status quo and a lack of computer literacy. Participants acknowledged benefits of reduced workloads, speed of accessing patient-level data and click-of-a-button reporting. Three factors influenced the ease of adopting the new system: firstly, implementation challenged the vertical position of the TB programme, TB data and staff’s conventional roles and responsibilities; secondly, perceptions of the paper-based register as functional and reliable made the transition to electronic seem unnecessary; and thirdly, lack of a process of change management challenged staff’s ability to internalise the proposed change. Conclusion: A process of change management is critical to facilitate the efficiency and effectiveness with which the electronic in-facility TB register is implemented.