The sustainability of the elimination of the mother-to-child HIV transmission (emtct) program in the Eastern Cape: quality improvement team’s perception

Williams, Dorothy (2018-03)

Thesis (MCur)--Stellenbosch University, 2018.

Thesis

ENGLISH SUMMARY: Background: The sustainability of the elimination of the Mother to Child HIV transmission (eMTCT) programme has decreased worldwide. The President's Emergency Plan for AIDS Relief (PEPFAR), and other collaborators engaged in the eMTCT program are faced with challenges in the implementation of programs or interventions that can cause a threat to program sustainability. The eMTCT interventions are beneficial to patients and their families and can contribute towards improvement and sustainable health outcomes. Sustainability of these interventions following the departure of the partners remains a concern. The purpose of this study was to explore the quality improvement team`s perception of the sustainability of the eMTCT Quality Improvement Collaborative(QIC) program implemented in the Mnquma sub-district in the Eastern Cape Province of South Africa using a quality improvement collaborative approach. Methods: A qualitative research methodology with a descriptive exploratory design was utilized in order to explore and describe the quality improvement team perceptions on the sustainability of the eMTCT QIC program. A purposive sampling method was used during participant selection from the 14 health clinics where the eMTCT QIC program was implemented. Two focus group discussions were conducted, one with four and the other with nine participants and also three individual interviews. A semi structured interview guide was used for both focus group discussions and the individual interviews. The interviews were audio taped and transcribed. Colaizzi`s method was applied during the data analysis. Results: The four themes that emerged from the data analysis were: Appreciating the QIC design; Program empowerment; Community influences and Development challenges to program sustainability. The participants became more resourceful following a good understanding of the quality improvement collaborative program. Emerging innovativeness enabled the participants to be excited about the quality improvement model and take ownership of the process and progress made during and after implementation of the QIC program. However, there are still gaps in the care and access to the management of the eMTCT program that still needs to be addressed. The participants overall views were that the eMTCT QIC program will continue to ‘holding the gains’. Conclusion: Planning for sustainability is very important from the beginning of any new intervention. Organisations must clarify what is going to be sustained. The involvement and collaboration from all stakeholders, especially community involvement, according to the researcher is vital for program sustainability. In conclusion, leadership buy-in, teamwork, communication and feedback, regular data management, staff support, motivation and acknowledgement may lead to continuous improvement.

AFRIKAANSE OPSOMMING: Agtergrond: Die volhoubaarheid van die eMTCT program het wêreldwyd gedaal. Die President se Noodplan vir Vigsverligting (PEPFAR) en ander medewerkers, het saamgestaan om die oordrag vanaf Moeder- na - Kind te elimineer (eMTCT), maar daar is steeds uitdagings met die implementering van programme of ingrypings wat ‘n bedreiging is vir die volhoubaarheid van die program. Die eMTCT intervensies is voordelig vir pasiënte en hul gesinne. Volhoubaarheid van hierdie ingrypings na die vertrek van die vennote bly 'n bron van kommer. Die doel van hierdie studie was om die gehalte verbeterings span se persepsies van volhoubaarheid van die eMTCT QIC program wat in die Mnquma subdistrik, Oos Kaap provinsie van Suid-Afrika geïmplementeer is, te ondersoek. Metodes: 'n Kwalitatiewe navorsings metodologie met 'n beskrywende verkennende ontwerp is gebruik om die gesondheidswerkers se persepsies oor die volhoubaarheid van die eMTCT QIC program te ondersoek. 'n Doelgerigte steekproef metode is gebruik tydens die deelname van die 14 gesondheidsklinieke waar die eMTCT QIC program geïmplementeer is. Daar was twee fokusgroep besprekings met vier en die ander met nege deelnemers. Verder is drie individuele in-diepte onderhoude gevoer. 'n Onderhoudsgids is gebruik vir beide fokusgroep besprekings en die in-diepte onderhoude. Die onderhoude was opgeneem met klankopnemers en getransskribeer. Colaizzi se metode is toegepas in die data analise. Resultate: Vier temas wat uit die data analise na vore gekom het was: Die waardering van die gehalte verbeterings benadering ontwerp; Program bemagtiging; Gemeenskapsinvloede en Ontwikkelingspunte vir volhoubaarheid van die program. Die deelnemers het meer vindingryk geraak aangesien hulle die program ontwerp beter verstaan het. Opkomende innovering het die deelnemers in staat gestel om meer opgewonde te wees oor die program ontwerp en eienaarskap te neem van die proses en vordering wat gemaak is gedurende die implementering van die eMTCT program. Daar is egter steeds tekortkominge in die sorg en toegang tot die bestuur van die eMTCT program wat aangespreek moet word. Deelnemers se algemene siening was dat die eMTCT QIC program sal voortgaan om die “Winste te behou”. Gevolgtrekking: Beplanning vir volhoubaarheid is baie belangrik vanaf die begin van enige nuwe ingryping. Organisasies moet seker wees oor wat volhoubaarnis moet wees. Die betrokkenheid en samewerking van alle belanghebbendes, veral gemeenskaps - betrokkenheid, volgens die navorser, is noodsaaklik vir program volhoubaarheid.Leierskap ondersteuning, spanwerk, kommunikasie en terugvoering, gereelde data bestuur, personeel ondersteuning, motivering en erkenning mag lei tot deurlopende verbetering.

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