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Publications

Filtering by Tag: Andrew McKenzie

Scaling up ART adherence clubs in the public sector health system in the Western Cape, South Africa: a study of the institutionalisation of a pilot innovation

Future Health Systems

MacGregor H, McKenzie A, Jacobs T and Ullauri A (2018) Scaling up ART adherence clubs in the public sector health system in the Western Cape, South Africa: a study of the institutionalisation of a pilot innovation, Globalization and Health, 14:40, DOI: 10.1186/s12992-018-0351-z

In 2011, a decision was made to scale up a pilot innovation involving ‘adherence clubs’ as a form of differentiated care for HIV positive people in the public sector antiretroviral therapy programme in the Western Cape Province of South Africa. In 2016 we were involved in the qualitative aspect of an evaluation of the adherence club model, the overall objective of which was to assess the health outcomes for patients accessing clubs through epidemiological analysis, and to conduct a health systems analysis to evaluate how the model of care performed at scale. In this paper we adopt a complex adaptive systems lens to analyse planned organisational change through intervention in a state health system. We explore the challenges associated with taking to scale a pilot that began as a relatively simple innovation by a non-governmental organisation.

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Building a Resilient Health System: Lessons from Northern Nigeria

Future Health Systems

The overarching aim of this paper is to address the issue of building resilient health systems in the context of the Ebola outbreak in West Africa which has brought renewed attention to this challenge. The paper highlights insight gained from two decades work creating resilient health systems in Nigeria—in Northern Nigeria in particular. In highlighting how the “simple” basics of outbreak control tie into larger, complex adaptive systems, this paper summarises key learning from the Nigerian experience as a basis for suggesting both how such outbreaks can be averted in the future and how sustainable development goals around eliminating excess mortality and improving health equity can be realised in practice.

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