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implementation, and ensure that they are communicated Acknowledgements
effectively. At each facility, staff should be allowed to tailor
some elements of implementation to their local contexts, for The authors thank the study participants for availing their
instance, the decision about who is best placed to capture TB time in helping to provide information for this research.
data, and provide support to develop sustainable plans for
maintaining the data. The following aspects of implementation Competing interests
should be addressed: the rationale for the transition, in
particular, the limitations of maintaining separate programme The authors have declared that no competing interests
data and the possibilities opened up for improving TB patient exist.
management and programme outcomes with decentralisation
and integration of TB data with those of other health Authors’ contributions
programmes; anticipate implementers’ potential distrust and
discomfort with the introduction of the electronic TB register, H.M., R.P.H.P., T.H. and G.H. conceived and designed the
potential fears about losing data quality, and their familiarity analysis. H.M. collected the data, synthesised findings and
with and trust in the functionality of the paper-based register produced the first draft of this article. R.P.H.P., T.H., C.J.G.
and the ETR.Net system. Also pre-emption and discussion of and G.H. provided analytic support, expert insights into
the process of identifying and reporting flaws and interpreting data and multiple revisions of the manuscript.
compatibility issues in the software, and detailing of the
support that is available if such issues were to arise. Funding information
This study is made possible by the generous support of the
Thirdly, it must be recognised that data use and analysis by American people through the US President’s Emergency Plan
facility managers and TB nurses will take time to cultivate; for AIDS Relief (PEPFAR) through the United States Agency
it is necessary to understand that the electronic register frees for International Development (USAID) under Cooperative
up the hands of sub-district level TB coordinators to provide Agreement number AID-674-A-12-00015, entitled Systems
health systems strengthening support to facilities by, for Strengthening for Better HIV/TB Patient Outcomes, and
instance, using data in real-time to check progress against Cooperative Agreement number 72067418CA00023 for the
targets.
Accelerating Program Achievements to Control the Epidemic
(APACE) Activity in South Africa to the Anova Health
Through highlighting key issues to address during Institute.
implementation, our study contributes to informing wide-
scale implementation of electronic TB data in South African
health facilities, and can inform the implementation of Data availability statement
electronic health information systems in favour of paper- Data sharing is not applicable to this article as no new
based systems globally. There are two limitations to the data were created or analysed in this study.
study. Firstly, the study uses interviews with participants a
year after the pilot project began to report on implementation,
thus asking participants to recall their experiences rather Disclaimer
than documenting their experiences in real-time. Secondly, The views and opinions expressed in this article are those of
this study was also limited by its focus on pilot sites in one the authors and do not necessarily reflect the official policy or
health district in the Western Cape Province which is not position of any affiliated agency of the authors.
necessarily representative of other settings within and
outside of South Africa. References
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