The impact of antiretroviral treatement scale-up on health systems in South Africa : a qualitative study.
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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.