South Africa

South Africa

In January and August 2012 I provided technical assistance to the national TB Control Program. This included (a) the assistance to the University Research Corporation (URC) in evaluating their pilot use of smartphones to monitor treatment of new TB patients; (b) the evaluation of the support provided by the URC to the South Africa TB Control Programme; and (c) the assistance to the SA TB Control Program in analysing the Electronic TB register.

Between May 2001 and May 2008 I provided technical assistance to the Department of Health (DOH) of KwaZulu-Natal to improve health planning and management. This was done by systematically reviewing published epidemiological information, analysing secondary data sets, and conducting surveys to fill the gaps. The information was then used to identify priorities, monitor implementation of key health programmes and evaluate their impact. Achievements included:
• Estimation of the Burden of Mortality. This was based on the analysis of the data sets on recorded death certificates that were obtained from the National Statistics Office of South Africa and on another data-set obtained from the Hlabisa demographic surveillance site. The analysis was done according to the Burden of Disease methodology and allowed the DOH to estimate for the first time the burden of mortality in the population;
• Estimation of the causes of hospitalization. A hospital discharge survey was carried out in all the 67 public hospitals of KZN to produce reliable causes of hospital discharges and deaths. This allowed the DOH to have for the first time a reliable statistic on the causes of hospitalization and to compare the mortality pattern in the hospitals vs. the mortality burden in the general population (see previous bullet);
• Validation of the indicators of hospital performance. This was done by carrying an audit of the information system in all the 67 public hospitals of KZN;
• Evaluation of the TB programme of the district of Umzinyathi. This was done by a survey of the clinic sites to audit the TB Register and to collect information on the characteristics of the clinics and patients. The information was analysed to validate published statistics and to identify predictors of treatment outcomes.
• Organization of a surveillance system to monitor an epidemic of extensively drug resistant TB in Umzinyathi district and to trace and test the contacts;
• Implementation of a complex retrospective study on primary and secondary data to estimate the cost-effectiveness of antiretroviral therapy (ART) in KZN, with the identification of cost-effective strategies to increase survival;
• Monitoring of HIV resistance through threshold surveys based on genotyping.
• Production and distribution of 16 issues of the DOH Epidemiological Bulletin; and
• An epidemiological data base.