Original Research

Transition to an in-facility electronic Tuberculosis register: Lessons from a South African pilot project

Hanlie Myburgh, Remco P.H. Peters, Theunis Hurter, Cornelius J. Grobbelaar, Graeme Hoddinott
Southern African Journal of HIV Medicine | Vol 21, No 1 | a1025 | DOI: https://doi.org/10.4102/sajhivmed.v21i1.1025 | © 2020 Hanlie Myburgh, Remco P.H. Peters, Theunis Hurter, Cornelius J. Grobbelaar, Graeme Hoddinott | This work is licensed under CC Attribution 4.0
Submitted: 26 August 2019 | Published: 16 January 2020

About the author(s)

Hanlie Myburgh, Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Remco P.H. Peters, Anova Health Institute, Johannesburg, South Africa
Theunis Hurter, Anova Health Institute, Johannesburg, South Africa
Cornelius J. Grobbelaar, Anova Health Institute, Johannesburg, South Africa
Graeme Hoddinott, Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa


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Abstract

Background: South Africa has one of the highest incidences of Tuberculosis (TB) globally. High co-morbid HIV prevalence complicates TB management and treatment outcomes. Growing evidence suggests that integrating the TB and HIV programmes will improve the overall results.

Objectives: To describe how TB programme staff at various levels of the South African health system responded to the transition from a paper-based to an electronic register of TB data integrated with HIV programme data.

Method: Three primary health service facilities in the Cape Winelands district, Western Cape province, South Africa served as pilot sites for implementation. Semi-structured interviews were conducted with 21 TB programme staff purposively selected at facility, sub-district, district and provincial levels of the health system, based on their involvement in implementing electronic TB data. An objective-driven thematic frame was used to analyse the data.

Results: Fears about the transition included reductions in data quality, changes to the status quo and a lack of computer literacy. Participants acknowledged benefits of reduced workloads, speed of accessing patient-level data and click-of-a-button reporting. Three factors influenced the ease of adopting the new system: firstly, implementation challenged the vertical position of the TB programme, TB data and staff’s conventional roles and responsibilities; secondly, perceptions of the paper-based register as functional and reliable made the transition to electronic seem unnecessary; and thirdly, lack of a process of change management challenged staff’s ability to internalise the proposed change.

Conclusion: A process of change management is critical to facilitate the efficiency and effectiveness with which the electronic in-facility TB register is implemented.


Keywords

TB programme; systems integration; monitoring and evaluation; roles and responsibilities; HIV

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