The success of our ART programme, made evident by improvements in SA’s life expectancy deserves to be celebrated, says Kobus van der Walt.
Cape Town - South Africa is home to the highest number of people living with HIV/Aids worldwide and the observation of World Aids Day is of particular importance to us. The success of our antiretroviral treatment (ART) programme, made evident by the recent improvements in the life expectancy of South Africans, deserves to be celebrated.
The national ART programme was launched in 2004 and has made access to life-saving treatment possible for millions of South Africans at a primary health-care level. A strong alliance exists between the South African government, business and civil society sectors, and the South African National Aids Council. This has provided rigorous leadership and direction in the National Strategic Plan for HIV, TB, and STIs, setting clear objectives and targets.
The development and growth of HIV/Aids health service programmes have not been without challenges, as illustrated by episodic antiretroviral drug stock-outs, the challenge of decentralising HIV/Aids treatment to primary health clinics, limited laboratory services, and poor quality of data to inform monitoring and evaluation of the programmes. But despite this the South African government achieved countrywide coverage of the ART programme, and aims to put more than 400 000 people on ART annually.
Upon reflecting on the successes of ensuring the national scale-up and coverage of HIV/Aids health services, it is important to consider whether the quality of these services have kept up with the sudden increase in HIV/Aids health service coverage and accessibility.
The emphasis on quality in HIV/Aids health services is occurring at a time when there is increasing national and international momentum towards making “quality” an organisational strategy of all health organisations. Many industries have used quality management principles successfully to improve performance. But what is “quality”? One of the most useful definitions is “the degree to which a system of production meets (or exceeds) the needs and desires of the people it serves”.
Defining the needs and the desires of clients of the health system is critical to determine the quality standards against which HIV/Aids services should be measured. Without clear standards and norms, informed by people living with HIV/Aids and their families and communities, the standards upon which the performance of the health system is measured risks being defined unilaterally by health system administrators.
So what are the existing quality standards for HIV/Aids health services and how will we know if organisations have embraced a culture of quality?
Quality standards are integrated in South African health policies, treatment guidelines, and strategic plans involving HIV/Aids. Each HIV/Aids health programme in the public sector has clear performance indicators to track progress and there are widespread efforts to support health managers in using data on health-system performance to guide improvement planning.
From the plethora of new health policies and strategic plans it is evident that organisational will and ideas exist for improving quality.
For the South African government to achieve nationwide quality of care in HIV/Aids services, additional human and capital investment is required to facilitate large-scale quality improvement initiatives – to create the organisational context in which quality improvement will occur, and to ensure the institutional support exists to spread and sustain improvement efforts across the whole health system.
* Dr Kobus van der Walt is clinical programme director of the South to South Programme for Comprehensive Family HIV Care & Treatment in the Department of Paediatrics and Child Health of the Faculty of Medicine and Health Sciences at Stellenbosch University.
** The views expressed here are not necessarily those of Independent Newspapers.