MAXIMIZING POSITIVE SYNERGIES - World Health Organization

The collection of information from different categories of respondents from diverse organizations
helped the team to assess whether there was consensus on the issues raised. The interviews
followed a question guide, with the scope of the questions focused on participants’ experiences
and views. The interviews lasted between 45 and 90 minutes, differing slightly as the interviewer
probed according to what was said by each interviewee. The interviews addressed both what had
been implemented with GHI support but also stakeholder perspectives on likely implications for
the broader health care system.
The purpose of the interview and the freedom to participate or withdraw if they so chose, were
verbally explained to each participant. Most interviews were carried out at the interviewees’ offices
while others were telephone interviews. All interviews were in English. Some of the interviews
were tape recorded, but where this was not possible detailed notes were taken. The interview
format was refined periodically in order to probe and explore leads on key issues that were not
clear.
Data analysis was an ongoing process using interpretive description as described by Thorne and
others [13]. Audio taped interviews were transcribed and analysed, with key themes identified
through this process. The consistency and reliability of the analysis process was improved through
the involvement of more than one analyst [14].
Results
Leadership, Governance and Coordination
South Africa’s position as a middle-income country with some of the highest HIV prevalence rates
in the world places it in the unique position of being able to fund its own health care system, while
receiving large amounts of external funding for HIV-specific services. Current GHI and donor
activity largely focuses on HIV/AIDS, though reliance on the state to coordinate and monitor
activities has had varied results. Most funding centres on HIV‐related areas such as home based
care, training and support of community health workers, supporting the rollout and scale‐up of
ART services, and the funding of community‐based HIV prevention organizations. Many clinically
based interventions are operationalized in conjunction with or through national and provincial
departments of health.
State health‐related policy guidelines in South Africa are generally strong, with strategic plans
regularly crafted to cover various areas [11]. Government policies currently include amongst
others: the HIV and AIDS and STI Strategic Plan 2007‐2011; the National Infection Prevention and
Control Policy for TB, MDRTB and XDRTB; and the Comprehensive HIV and AIDS Care, Management
and Treatment Plan for South Africa. In addition to specific health‐related policies, state planning
follows the principles of the Reconstruction and Development Program (RDP) and other
macro‐economic strategies. South Africa’s federal governance system gives provinces the ability to
interpret national policy according to their own priorities, with funding from the national level
allocated according to need. Post-apartheid restructuring of the public health sector has focused
significantly on promoting equity.
Donors are also expected to follow state guidelines, and many do seek to align with government
priorities and policies. However, the imperative of addressing focal diseases, along with local
political conditions, has led to most donor‐funded projects being concentrated in specific regions
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