HIV/AIDS/STI/TB care and referral across levels of care (from community to tertiary care)FINAL Report

This report describes a four-year Own Initiative (OI) project sponsored by the VLIR-IUC program between the Vrije Universiteit Brussel, Belgium, and the University of Limpopo, South Africa. Project activities were supported by the Provincial Department of Health and implemented in partnership with the Departments of Community Health and Family Medicine of Campus Polokwane, and the Department of Nursing and Health Promotion of Campus Turfloop. The project was conducted from May 1, 2004, until April 30, 2008, after a one year extension was granted by VLIR due to administrative delays in obtaining approval for third year project activities.
The report is conceived as a narrative of IR-related objectives and activities, and entails the description of results related to the overall developmental and academic objectives of research, capacity building and extension. Although the timeline proved problematic due to rather ambitious project goals, coupled with an initial lack of local ownership and the multidisciplinary nature of the OI partnership, both research and capacity building related objectives were largely achieved, culminating in the formulation of a new project proposal at the end of the second operational year and renewed interest from the local stakeholder in VLIR project activities.
Research related activities were conducted in a predefined and by the local counterpart approved project area, comprising a job satisfaction survey among rural PHC nurses and an HIV/AIDS/STI knowledge, attitudes, and practices (KAP) survey of PHC and hospital health staff. Both studies were conducted through the Department of Community Health of Campus Polokwane, and results were disseminated among local stakeholders through a written summary report and an annual research forum organized by Provincial health authorities. After hand-over of project coordination an HIV/AIDS/STI household survey and pre- and post intervention survey was also conducted by the Health Promotion Unit.
Activities related to capacity building comprised upgrade and support of a postgraduate training for PHC nurses, organized at Campus Turfloop and consisting of both residential and in-service training modules. VLIR support consisted of administrative and logistical assistance, in particular regarding the HIV/AIDS/STI part of a chronic diseases module, where new and innovative tools were used for teaching analytical and problem solving skills. Support was also given to the organization of structured clinical examinations and the implementation of a research module, where nurses were tasked with individual and group assignments as required for academic qualification.
Although the training suffered from continued lack of transparency and mismanagement due to lack of capacity, the training proved highly successful both for students and their lecturers. Students reported to be satisfied with course content and interactive learning techniques, but dissatisfied with course organization and the lack of textbooks. The lack of recognition by Provincial health authorities hampered the recruitment of local nurses, which resulted in a collaboration with the Mpumalanga Province. Collaboration with the Department of Family Health was also essential to achieve the developmental objectives.
The project proved to be a real challenge in terms of overcoming the many bottlenecks associated with implementing this North/South development project characterized by limited resources, but rather ambitious project goals. Collaboration with the Department of Community Health proved to be problematic due to high turnover of staff members and the lack of local capacity. Interference of Provincial health politics moreover created a climate of profound distrust and only after hand-over of project coordination to a new
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counterpart (Health Promotion Unit) could successful cooperation with stable outcomes be ensured.
At that stage, a new project proposal was launched comprising the pilot implementation of a health promoting hospital in the project area. This proposal instilled renewed vigor in the interuniversity collaboration and led to successful extension of the project aimed at research and capacity building of the new counterpart. The delay in formal approval by Provincial health authorities, however, necessitated a request to VLIR for granting an extension of the project with a fourth operational year, which eventually resulted in the successful achievement of project objectives and the official launch of the hospital as a health promoting hospital.