The politics of tuberculosis and HIV service integration in Ghana.
Identifieur interne : 000430 ( Main/Exploration ); précédent : 000429; suivant : 000431The politics of tuberculosis and HIV service integration in Ghana.
Auteurs : Joshua Amo-Adjei [Ghana] ; Akwasi Kumi-Kyereme [Ghana] ; Hannah Fosuah Amo [Ghana] ; Kofi Awusabo-Asare [Ghana]Source :
- Social science & medicine (1982) [ 1873-5347 ] ; 2014.
Descripteurs français
- KwdFr :
- Ghana, Humains, Infections opportunistes liées au SIDA (), Infections opportunistes liées au SIDA (économie), Infections à VIH (), Infections à VIH (économie), Intégration de systèmes, Politique, Politique de santé (économie), Prestations des soins de santé (organisation et administration), Prestations des soins de santé (économie), Tuberculose (), Tuberculose (économie).
- MESH :
- organisation et administration : Prestations des soins de santé.
- économie : Infections opportunistes liées au SIDA, Infections à VIH, Politique de santé, Prestations des soins de santé, Tuberculose.
- Ghana, Humains, Infections opportunistes liées au SIDA, Infections à VIH, Intégration de systèmes, Politique, Tuberculose.
- Wicri :
- geographic : Ghana.
English descriptors
- KwdEn :
- AIDS-Related Opportunistic Infections (economics), AIDS-Related Opportunistic Infections (prevention & control), Delivery of Health Care (economics), Delivery of Health Care (organization & administration), Ghana, HIV Infections (complications), HIV Infections (economics), HIV Infections (therapy), Health Policy (economics), Humans, Politics, Systems Integration, Tuberculosis (complications), Tuberculosis (economics), Tuberculosis (prevention & control).
- MESH :
- geographic : Ghana.
- complications : HIV Infections, Tuberculosis.
- economics : AIDS-Related Opportunistic Infections, Delivery of Health Care, HIV Infections, Health Policy, Tuberculosis.
- organization & administration : Delivery of Health Care.
- prevention & control : AIDS-Related Opportunistic Infections, Tuberculosis.
- therapy : HIV Infections.
- Humans, Politics, Systems Integration.
Abstract
The need to integrate TB/HIV control programmes has become critical due to the comorbidity regarding these diseases and the need to optimise the use of resources. In developing countries such as Ghana, where public health interventions depend on donor funds, the integration of the two programmes has become more urgent. This paper explores stakeholders' views on the integration of TB/HIV control programmes in Ghana within the remits of contingency theory. With 31 purposively selected informants from four regions, semi-structured interviews and observations were conducted between March and May 2012, and the data collected were analysed using the inductive approach. The results showed both support for and opposition to integration, as well as some of the avoidable challenges inherent in combining TB/HIV control. While those who supported integration based their arguments on clinical synergies and the need to promote the efficient use of resources, those who opposed integration cited the potential increase in workload, the clinical complications associated with joint management, the potential for a leadership crisis, and the "smaller the better" propositions to support their stance. Although a policy on TB/HIV integration exists, inadequate 'political will' from the top management of both programmes has trickled down to lower levels, which has stifled progress towards the comprehensive management of TB/HIV and particularly leading to weak data collection and management structures and unsatisfactory administration of co-trimoxazole for co-infected patients. It is our view that the leadership of both programmes show an increased commitment to protocols involving the integration of TB/HIV, followed by a commitment to addressing the 'fears' of frontline service providers to encourage confidence in the process of service integration.
DOI: 10.1016/j.socscimed.2014.07.008
PubMed: 25042543
Affiliations:
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Le document en format XML
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<front><div type="abstract" xml:lang="en">The need to integrate TB/HIV control programmes has become critical due to the comorbidity regarding these diseases and the need to optimise the use of resources. In developing countries such as Ghana, where public health interventions depend on donor funds, the integration of the two programmes has become more urgent. This paper explores stakeholders' views on the integration of TB/HIV control programmes in Ghana within the remits of contingency theory. With 31 purposively selected informants from four regions, semi-structured interviews and observations were conducted between March and May 2012, and the data collected were analysed using the inductive approach. The results showed both support for and opposition to integration, as well as some of the avoidable challenges inherent in combining TB/HIV control. While those who supported integration based their arguments on clinical synergies and the need to promote the efficient use of resources, those who opposed integration cited the potential increase in workload, the clinical complications associated with joint management, the potential for a leadership crisis, and the "smaller the better" propositions to support their stance. Although a policy on TB/HIV integration exists, inadequate 'political will' from the top management of both programmes has trickled down to lower levels, which has stifled progress towards the comprehensive management of TB/HIV and particularly leading to weak data collection and management structures and unsatisfactory administration of co-trimoxazole for co-infected patients. It is our view that the leadership of both programmes show an increased commitment to protocols involving the integration of TB/HIV, followed by a commitment to addressing the 'fears' of frontline service providers to encourage confidence in the process of service integration.</div>
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