A qualitative study describing provider perspectives on the influence of external support on the quality of HIV and TB services at public health clinics in Ekurhuleni, South Africa

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Abstract Background: To combat the HIV epidemic in South Africa, stronger health systems are needed to maintain progress towards reaching the UNAIDS 95-95-95 goals. South Africa’s National Department of Health (NDoH) has supported various health systems strengthening (HSS) strategies that include the Ideal Clinic programme. This study sought to describe the perceptions of health workers on how support from a PEPFAR-funded implementing partner (IP) contributed to HSS activities in Ekurhuleni District’s Ideal Clinics. We explored the perceptions of health workers on how external support from an IP influenced the quality of HIV/TB services at primary health clinics (PHCs). Methods: We conducted a qualitative study at five clinics in the Ekurhuleni district, Gauteng Province, South Africa. Purposive sampling was used to include clinics in different sub-districts with varying status within the “Ideal Clinic” programme, which is a NDoH initiative to strengthen health systems by improving quality of care. From October to December 2019, 30 in-depth interviews were conducted with health workers using semi-structured interview guides. Health workers, employed for more than 3 months and involved in providing TB and HIV services, were invited to participate. Interview data were analysed using thematic content analysis. Results: Most staff perceived the overall quality of HIV/TB services as high. Clinic staff felt that the IP’s provision of material and human resources was useful and contributed to improving the quality of health service delivery. Staff perceived training and the presence of guidelines on service provision as beneficial and that it should be increased. Communication with the IP facilitated the provision of quality HIV/TB services, but increased open communication was recommended especially with regards to changes made to service provision and handover of patients. Conclusion: Staff perceived that external support received from the IP improved the quality of HIV/TB services provided. Health systems are strengthened by such improvements in the quantity and quality of services offered. External partners provide valuable technical support to health facilities. Ensuring that there is adequate attention paid to communication and relationship-building with clinic staff may help to improve collaboration and overall quality of care.

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