Marseille 2007
| Abstract #225 - RESEARCH TO ASSESS LOCAL LEVEL FUNCTIONAL INTEGRATION OF HIV AND AIDS SERVICES IN SOUTH AFRICA | ||||
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Session: 26.16: Posters B (Poster) on Tuesday in Chaired by Authors: Presenting Author: Mr Leon Swartz - Natrional Department of Social Development, South Africa |
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| Additional Authors: | ||||
| Aim: The aim of the study was: 1. To identify and review literature on local and international experience in integration of HIV & AIDS services at local level. 2. To assess the level of integration of HIV & AIDS services at local level, including planning, management and delivery of services 3. To identify critical success factors, strengths and challenges in the provision of integrated HIV & AIDS services at local level with particular reference to the community and home-based care and the needs of orphans and vulnerable children. 4. To identify gaps in planning, management and implementation of integrated HIV & AIDS services at local level. 5. To document the key elements and achievements of specific integration programmes such as may exist in pilot sites. 6. To propose an effective and efficient approach towards functional integrated delivery of HIV & AIDS services at local level, which will include guidelines for implementing an integrated approach in planning and implementing HIV & AIDS services at local level. | ||||
| Method / Issue: The study is largely cross- sectional and descriptive and will involve a multi-pronged approach aimed at obtaining information to assist in assessing the extent to which government and civil society in South Africa has tackled the problem of service fragmentation in the delivery of HIV and AIDS services by governmental and non-governmental agencies. One component of this is a review of the literature on the subject of integration of HIV and AIDS services. The researcher will try to interpret local practice in this context. The researcher aimed to carry out 21 interviews per province (site), making an overall total of 189 interviews (45 users of services and 144 service providers (representing both government and civil society). In addition there would be focus group discussion and participatory activities with a beneficiary group of about 12 persons per site. | ||||
| Results / Comments: Some of the results is as follows: 1. Create an environment for easy understanding and implementation of functional integration by allowing local managers some budgetary flexibility in undertaking collaborative and joint planning activities. 2. Increase the numbers and capacity of staff in government and CSO sectors, specifically HIV and AIDS coordinators at all levels of government, service professionals and home-based carers. 3. Provide training, debriefing and motivation for staff, especially around ethics and confidentiality. 4. Improve procurement and distribution systems. Provide material resources for HCBC caregivers (gloves, detergents, basic medication). Consistently supply food parcels where needed. 5. Increase the responsibilities allocated to HCBC caregivers, reviewing the stipend systems to ensure that rewards are more reasonably aligned to workload and responsibility. 6. Invest in civil society, and particularly in organisational development and leadership training. Develop accredited qualifications and career paths around civil society contribution. 7. Support the role of schools and clinics as community centres, including funded opportunities to provide comprehensive services from these centres. | ||||
| Discussion: This study has clearly documented pivotal views and experiences of service providers and service users on issues relating to functional integration of HIV and AIDS services. The later represent beneficiaries who are benefiting from, and those who have encountered difficulties with, coordination and integration of services. The implementation of the recommendations listed at the end of this section should lead to improved policies and programmes to scale-up services and increase coverage, better organisation and reduced duplication of services, networking and emotional support structures created across services. However, the study found that there are no obvious indications among persons interviewed of what constitutes integration, how it might be measured, and what exactly its purpose should be and how its achievements could be monitored. This is despite the fact that the literature provides a rich language relating to the organisation of services and the interrelationships between servicesco-operation, collaboration, networking, comprehensiveness, partnership, co-ordination, joint working, integration, functional integration, and others. These terms and concepts inspire thoughts, assist analysis, inform policy, and shape practice. But their meaning is not always clear, and the same term is not consistently applied by different users. Despite these challenges, we have been able to extract useful experiences from each of the nine study sites that provide a powerful set of themes of emerging issues concerning functional integration across the country. | ||||
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