| Summary: | This study investigates the impact of the scale-up of antiretroviral treatment (ART) on the
health system in South Africa. It looks at the positive and negative effects of treatment
scale-up on human resources and staff morale, on HIV prevention programmes, and on
other health system programmes, looking specifically at the integration of programmes
and the use of infrastructure. There is much debate as to the place of treatment as a
response to the epidemic because it has been found to be less cost-effective than
prevention interventions. However this study argues that it is difficult to accurately
assess cost effectiveness because it does not take into account other ways in which
treatment may be effective, such as its impact on other aspects of health care, most
notably on staff morale and on prevention. Thus this study investigates the impact of
treatment intervention on the health system as a whole in order to determine the
effectiveness of treatment as a policy response.
This research uses data collected in 2006 at two sites in South Africa: the Ilembe district
in KwaZulu-Natal province and the Cape Winelands Region in the Western Cape
province. Twenty-one health care professionals were interviewed across the two sites in
order to determine their perspectives on the impacts of ART scale-up on these aspects of
the health care system. Interviews were conducted at hospitals, clinics and on hospice
where ART was being administered
ART scale-up, as predicted, was having a mixed impact on the health system as a whole.
For the most part, the programmes were not having negative impacts on the rest of the
health system in the form of taking infrastructure, funding, or human resources from
other departments. The programmes, on separate budgets, were not directly taking
resources from other departments, although there were some instances of borrowing
space, staff, or equipment when necessary. The treatment programmes were reported to
be adding further strain to an already resource-limited health care system, which was
most notable in the issues of space and staff shortages. In addition, the treatment
programmes did not appear to be bringing in additional funding, staff development, or
infrastructure to benefit the health system as a whole.The major positive impact of the ART rollout on the health system was creating positive
staff morale and a sense of hope throughout the health system. The health system was
now able to address HIVIAIDS and was able to provide treatment whereas prior to rollout
there was little apart from palliative care that could be done for people living with
HIVIAIDS. In addition, treatment was adding to prevention efforts by raising awareness
in the community about HIV/AIDS and by increasing uptake of voluntary counseling and
testing.
There is a need to address the resource limitations in the health care system, most notably
human resource shortages. The success of treatment programmes was dependent on
having motivated and dedicated staff. It is necessary to further attract and retain health
care professionals to the field in order to ensure the sustainable success of ART rollout.
Funding also needs to be addressed to ensure that sustainable resources are available to
support the ever-growing needs of the treatment programmes. === Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2008.
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