Health Systems Strengthening


Health Systems Strengthening for Improved HIV-TB Outcomes

The Wits RHI Health Systems Strengthening (HSS) programme is a USAID-PEPFAR-funded project to improve HIV and TB outcomes - and strengthen broader health systems - by providing direct service delivery to the Department of Health at facility level, and technical assistance at all levels of the DoH: national, provincial, district and facility. Technical assistance includes training and mentoring; quality improvement as well as policy development and roll out guidance. The project is currently implemented in one urban and one semi-urban district: Sub-District F of the
Johannesburg Health District and Dr Kenneth Kaunda District of North West Province. The project is supported through the efforts of technical experts based in the Hillbrow Health Precinct, and through roving and facility based, clinical and technical assistance teams based in two district offices located in Gauteng and North West provinces.

In 2015, HSS, guided by the PEPFAR focus for impact strategy, supported the implementation of the South African National Department of Health-led UNAIDS 90-90-90 policy to ensure that 90% of People Living with HIV (PLHIV) are diagnosed, 90% initiated on antiretrovirals and 90% are suppressed on treatment. In striving to achieve these objectives, the mandate of HSS is to ensure that PLHIV in Sub-District F, JHD and DKK districts are diagnosed; initiated on ARVs; retained in care; and virologically suppressed.

HSS supports 90-90-90 in funded districts using a three-tier strategic approach: Hospital; Primary Health Care (PHC) and Community Outreach. The Hospital Strategy is aimed at rapid identification of HIV positive patients in hospitals and strengthening of referral systems to ensure linkage to care and initiation of all HIV infected patients on ART. The PHC Strategy aims to ensure all referred and facility PLHIV are tested for HIV, initiated on ART and retained in care. Lastly, the Community Outreach Strategy is aimed at targeting PLHIV who do not readily access facilities and promoting HIV testing within the community and linkage to care to facilities. The Community Outreach Strategy also supports retention in care of stable patients on ART through Community based ART services.

40 Clinics and 4 Hospitals in Dr Kenneth Kaunda District (DKK), North West
16 Clinics and 2 Hospitals in Sub district F, Johannesburg Health District, Gauteng

Goal: strengthen health systems for better HIV/TB patient outcomes.

Project Objectives:
Objective 1: Improve HIV and TB-related patient outcomes by strengthening health and patient management systems at facility, sub-district and district levels.
Objective 2: Build capacity of facility, sub-district, and district management systems in coordination with provinces to strengthen health systems in support of HIV-related services.
Objective 3: Provide support for development and successful implementation of SAG policies for HIV and TB-related interventions.

Chief of Party: Dr. Gloria Maimela, Director Health Systems Strengthening
Technical Lead: Dr. Nicola Wattrus Technical Head for Health Systems Strengthening
Dr. Lee Fairlie, Director of Child and Adolescent Health
Cleopatra Sokhela: Head of Strategic Information
Lindiwe Farlane, Technical Head: M&E


National Department of Health
Provincial Departments of Health: Gauteng, North West
District Departments of Health:
Gauteng: City of Johannesburg
North West: Dr Kenneth Kaunda;

Conference Abstracts
1. Lauren Golden, Lee Fairlie, Craig Parker, Enoch Manyame, Freda Might, Stina Modise, Dorothy Motsamai, Suzan Motshepe, Z Motala. Improvement in Antenatal Clinic (ANC) HIV retest rate in the setting of high ANC HIV acquisition rates in primary care facilities in the Matlosana subdistrict, North West (NW) Province. Oral presentation, South African AIDS Conference, Durban 9-12 June 2015.
2. Chandiwana, N. Mothle A, Kgosana G, Mollo M , Mokalapa O, Fairlie L, Chauke K , Magagula N. Analysis of Universal HIV Testing of Infants at an Immunisation Clinic in Johannesburg, South Africa: A Quality Improvement Project. SAAIDS, 2015. June 2015
3. Chandiwana N, Fairlie L. Challenges of prevention of mother-to-child transmission in a perinatally HIV-infected pregnant adolescent failing a second line antiretroviral regimen in South Africa. South African HIV Clinicians Society Conference. September 2014.
4. Kgosana, G. Makgatho, F. Martin, C. Austin Evelyn,K. The role of the ICDM champion in implementing ICDM at a Community Health Centre in Johannesburg. SAAIDS, 2015. June 2015
5. Kgosana, G. Thomson, K. Wattrus, N. Change Management in an antenatal clinic in Johannesburg, Gauteng. SAAIDS, 2015. June 2015

Desmond Kegakilwe: Stop Stock Outs Project – Introduction, Goals, Survey and Collaboration with DoH Post Survey. SAAIDS 2015, June 2015