NU2GGH002394

Improving HIV/TB Policy Implementation in the KwaZulu Natal (KZN) Province in South Africa under the President's Emergency Plan for AIDS Relief (PEPFAR)

KwaZulu-Natal (KZN) is one of the nine provinces in South Africa (SA), the second most populous and predominantly rural with a population density of 120/km². The proportion of the population with medical insurance is 12.4, which puts pressure on the public health system.

KZN is confronted with a quadruple burden of disease, namely: 1) HIV and TB, 2) high maternal and child morbidity and mortality, 3) rising non-communicable diseases, and 4) high levels of violence and trauma. The province is the epicenter of HIV and TB in the country. Hence, this warrants support efforts to prevent, detect, respond, and treat infectious and non-infectious diseases that impact on people living with HIV (PLWHIV) and those infected by TB.

The province embraces an integrated approach in its quest towards epidemic control. KZN works as a collective, sharing lessons from Siyenza facilities, i.e. facilities with a high burden of HIV and TB, receiving intensive support from implementing partners and the Department of Health (DOH) provincial anchors. The province aims to establish a culture of continuous learning to strengthen health systems and achieve epidemic control.

Programme managers are the primary target population for this grant as they are at the forefront of HIV and TB policy implementation. There are sound policies; the challenge is translating these policies into implementation and institutionalization. It is envisaged that the Leadership Empowerment Programme can contribute immensely to the provision of strategic direction through policy formulation, implementation, and institutionalization. Additional funding is sought to address gaps by expanding particular technical aspects of provincial leadership to adequately support operational implementation of policies.

The information management capacity is limited yet critical to enhance understanding of the context and to develop tailored interventions to improve HIV and TB outcomes. KZN DOH recognizes the complexity of the landscape that it operates in, hence its collaboration on a broader scale to influence and impact population health. It aims to ensure optimization of available resources, technologies, and skills in order to reduce morbidity and mortality from HIV, TB, and NCDs. These collaborations will enable standardization of approaches to programmatic implementation throughout the process and reduce duplication.

Routine HIV and TB health information will be utilized to measure performance. The province will conduct monthly and quarterly performance review meetings to inform quality improvement activities. While the province is ambitious to achieve HIV and TB program deliverables, the funding allocation is limited. The provincial needs and gaps are substantial, and therefore decisions on key priority areas for the Center for Disease Control (CDC) funding are strategic. KZN has fiscal discipline, evidenced by clean HIV and TB conditional grant audits for three consecutive years. It is envisaged that these interventions will culminate in the improvement of health outcomes.

KZN has demonstrated the capacity and willingness to improve the health of PLWHIV and those infected with TB, evidenced by the province being first in the country to achieve 90-90-90 targets in four districts. Furthermore, it is pursuing the development of responsive systems that provide innovative solutions to current and future HIV and TB program challenges. KZN is committed to health systems strengthening in its endeavor towards epidemic control in 2030.

Kwazulu-Natal Provincial Government

NOT APPLICABLE

93.067 - Global AIDS

CDC Office of Financial Resources (OFR) [HHS - CDC]

Center for Global Health (CGH) [HHS - CDC]

South Africa

Foreign

Improving HIV/TB Policy Implementation in the KwaZulu Natal (KZN) Province in South Africa under the President's Emergency Plan for AIDS Relief (PEPFAR) (CDC-RFA-GH21-2133)

Amendment Since initial award the total obligations have increased 535% from $500,000 to $3,175,001.