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Administrative integration of vertical HIV monitoring and evaluation into health systems: a case study from South Africa
BACKGROUND: In light of an increasing global focus on health system strengthening and integration of vertical programmes within health systems, methods and tools are required to examine whether general health service managers exercise administrative authority over vertical programmes. OBJECTIVE: To...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Co-Action Publishing
2013
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3556718/ https://www.ncbi.nlm.nih.gov/pubmed/23364092 http://dx.doi.org/10.3402/gha.v6i0.19252 |
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author | Kawonga, Mary Fonn, Sharon Blaauw, Duane |
author_facet | Kawonga, Mary Fonn, Sharon Blaauw, Duane |
author_sort | Kawonga, Mary |
collection | PubMed |
description | BACKGROUND: In light of an increasing global focus on health system strengthening and integration of vertical programmes within health systems, methods and tools are required to examine whether general health service managers exercise administrative authority over vertical programmes. OBJECTIVE: To measure the extent to which general health service (horizontal) managers, exercise authority over the HIV programme's monitoring and evaluation (M&E) function, and to explore factors that may influence this exercise of authority. METHODS: This cross-sectional survey involved interviews with 51 managers. We drew ideas from the concept of ‘exercised decision-space’ – traditionally used to measure local level managers’ exercise of authority over health system functions following decentralisation. Our main outcome measure was the degree of exercised authority – classified as ‘low’, ‘medium’ or ‘high’ – over four M&E domains (HIV data collection, collation, analysis, and use). We applied ordinal logistic regression to assess whether actor type (horizontal or vertical) was predictive of a higher degree of exercised authority, independent of management capacity (training and experience), and M&E knowledge. RESULTS: Relative to vertical managers, horizontal managers had lower HIV M&E knowledge, were more likely to exercise a higher degree of authority over HIV data collation (OR 7.26; CI: 1.9, 27.4), and less likely to do so over HIV data use (OR 0.19; CI: 0.05, 0.84). A higher HIV M&E knowledge score was predictive of a higher exercised authority over HIV data use (OR 1.22; CI: 0.99, 1.49). There was no association between management capacity and degree of authority. CONCLUSIONS: This study demonstrates a HIV M&E model that is neither fully vertical nor integrated. The HIV M&E is characterised by horizontal managers producing HIV information while vertical managers use it. This may undermine policies to strengthen integrated health system planning and management under the leadership of horizontal managers. |
format | Online Article Text |
id | pubmed-3556718 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | Co-Action Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-35567182013-01-28 Administrative integration of vertical HIV monitoring and evaluation into health systems: a case study from South Africa Kawonga, Mary Fonn, Sharon Blaauw, Duane Glob Health Action Building New Knowledge Supplement BACKGROUND: In light of an increasing global focus on health system strengthening and integration of vertical programmes within health systems, methods and tools are required to examine whether general health service managers exercise administrative authority over vertical programmes. OBJECTIVE: To measure the extent to which general health service (horizontal) managers, exercise authority over the HIV programme's monitoring and evaluation (M&E) function, and to explore factors that may influence this exercise of authority. METHODS: This cross-sectional survey involved interviews with 51 managers. We drew ideas from the concept of ‘exercised decision-space’ – traditionally used to measure local level managers’ exercise of authority over health system functions following decentralisation. Our main outcome measure was the degree of exercised authority – classified as ‘low’, ‘medium’ or ‘high’ – over four M&E domains (HIV data collection, collation, analysis, and use). We applied ordinal logistic regression to assess whether actor type (horizontal or vertical) was predictive of a higher degree of exercised authority, independent of management capacity (training and experience), and M&E knowledge. RESULTS: Relative to vertical managers, horizontal managers had lower HIV M&E knowledge, were more likely to exercise a higher degree of authority over HIV data collation (OR 7.26; CI: 1.9, 27.4), and less likely to do so over HIV data use (OR 0.19; CI: 0.05, 0.84). A higher HIV M&E knowledge score was predictive of a higher exercised authority over HIV data use (OR 1.22; CI: 0.99, 1.49). There was no association between management capacity and degree of authority. CONCLUSIONS: This study demonstrates a HIV M&E model that is neither fully vertical nor integrated. The HIV M&E is characterised by horizontal managers producing HIV information while vertical managers use it. This may undermine policies to strengthen integrated health system planning and management under the leadership of horizontal managers. Co-Action Publishing 2013-01-24 /pmc/articles/PMC3556718/ /pubmed/23364092 http://dx.doi.org/10.3402/gha.v6i0.19252 Text en © 2013 Mary Kawonga et al. http://creativecommons.org/licenses/by/2.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Building New Knowledge Supplement Kawonga, Mary Fonn, Sharon Blaauw, Duane Administrative integration of vertical HIV monitoring and evaluation into health systems: a case study from South Africa |
title | Administrative integration of vertical HIV monitoring and evaluation into health systems: a case study from South Africa |
title_full | Administrative integration of vertical HIV monitoring and evaluation into health systems: a case study from South Africa |
title_fullStr | Administrative integration of vertical HIV monitoring and evaluation into health systems: a case study from South Africa |
title_full_unstemmed | Administrative integration of vertical HIV monitoring and evaluation into health systems: a case study from South Africa |
title_short | Administrative integration of vertical HIV monitoring and evaluation into health systems: a case study from South Africa |
title_sort | administrative integration of vertical hiv monitoring and evaluation into health systems: a case study from south africa |
topic | Building New Knowledge Supplement |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3556718/ https://www.ncbi.nlm.nih.gov/pubmed/23364092 http://dx.doi.org/10.3402/gha.v6i0.19252 |
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