Page 261 - HIVMED_v21_i1.indb

Page 4 of 7 Original Research

‘I kicked against the [electronic] system…because I felt that progression in management of TB data. This related to the
I was … a safety net [for data quality].’ (Participant 11, female, TB integration of TB programme data with general health
manager, 05 August 2016) information management, and to the broader notion that the
TB programme should move with the time:
In one instance, fears over reduction in data quality caused a
manager to undermine the register’s implementation: ‘Anyone looking for TB data in the country must get data from
the TB programme (and not from Health Information
‘[The TB manager] didn’t want us to spend time on the computer Management like with all other programmes). Integrated
[and implement the register], just wanted the paper. We decided systems is the answer.’ (Participant 19, female, TB manager, 13
that we’re going to continue [to implement], we’re going to show September 2016)
them it works. Show them how we print reports, how quick it is.’
(Participant 1, female, clerk, 01 July 2016) ‘All other [programmes] are on [electronic] systems. That’s why TB
must move away from paper-based. It might get resistance from
some of the clinics, but usually it’s because people don’t
To allay fears over TB case registration and maintenance of understand.’ (Participant 13, male, TB manager, 25 August 2016)
data quality, all three facilities kept parallel paper-based and
electronic registers at the start of implementation and Some participants expressed serious concerns about the
monthly data audits were conducted throughout. While integration of TB data with the existing HIV data
some TB managers continued to hold apprehensions over infrastructure, TIER.Net. For some, their siloed work had
data quality, they also saw the potential of the electronic given them little to no experience with the TIER.Net software,
register to increase ownership of TB data at facility level: while others’ concerns were informed by the gaps they
‘I hope and trust that ownership [of the data] will be better perceived in TIER.Net’s HIV and ART modules, which
because the data is not going far away to someone who captures negatively influenced confidence in the new system’s ability
it, the data is here in my clinic and I capture it myself.’ (Participant to effectively maintain TB data:
13, male, TB manager, 25 August 2016)
‘We have a lot of work to do on the quality of capturing [HIV
Prior to the transition to the electronic register, using TB data programme data] on TIER.Net, now we add the additional burden
for patient management required manual interrogation of of TB … How can you go from point A to point B if your point A
things aren’t correct yet?’ (Participant 11, female, TB manager, 05
patient folders to identify patients who missed sputum August 2016)
collection or who were experiencing treatment interruptions.
This was labour and time-intensive and could not be regularly This first pilot implementation of the electronic in-facility TB
conducted by the three facilities without support. Yet, the register highlighted some flaws in the software, producing
notion that the electronic TB register offered click-of-a-button erroneous reports on key TB indicators. This caused some
in-facility access to data for patient management and participants to question the integrity of the new programme,
improved reporting was not realised at initial introduction: and TB coordinators felt that they were responsible for
‘[The implementing partner] told us everything that we see now: resolving technical issues despite first and foremost being
”You will easily see that patients are late.“ We said ”We won’t, clinicians. Despite these challenges, regular meetings of TB
we’ll still have to go through the folders.” Everything he said is programme stakeholders during implementation and
[true/we were wrong].’ (Participant 6, female, nurse, 19 August training of in-facility staff (clerks and clinicians) on the
2016)
electronic TB register kept momentum for implementation.
Perceptions about the ‘new’ electronic and ‘old’
paper-based register How acceptance of the ‘new’ system was
facilitated
Participants across all levels of the health system expressed In preparing facilities as implementation sites, efforts
familiarity with and confidence in the ETR.Net surveillance
system and the paper-based registers that support it: focussed largely on coalface implementers. Managers were
primarily involved to follow due consultative process rather
‘You can go to anyone in the Department of Health in the Western than as advisors and decision-makers in the implementation
Cape and they will tell you that the only reliable data is TB data. process. Department of Health implementers and
With all the mistakes in the systems [of other health programmes]
the only reliable data is TB data.’ (Participant 19, female, TB implementing partners supported the transition by training
manager, 13 September 2016) clerks and TB clinicians on the electronic register and
completion of clinical stationery, resource allocation
‘It was difficult for [the nurses] to let go of those papers. They
were clinging to their register, ”Don’t take my register away!“’ (computers and additional staff during back-capturing active
(Participant 9, female, TB manager, 23 August 2016) TB clients) and continuous feedback meetings during
implementation. While some participants felt that these
Accordingly, when the electronic in-facility TB register was processes were sufficient, others expressed anxieties about
introduced, some participants felt that it was an unnecessary how the decision to pilot the electronic facility level TB
change as it replaced a working system. Despite their register was taken, discussions on how this change would be
apprehensions, managers in the TB programme recognised implemented and the broader implications for the TB
the transition to an electronic in-facility register as a logical programme and their roles:

http://www.sajhivmed.org.za 253 Open Access