Background
Methods
Angola | Burundi | Lesotho | Mozambique | SA | |
---|---|---|---|---|---|
Ethics approval | National and provincial health authorities | National ethics committee | Ethics committee of the Ministry of Health and Social Welfare | National bioethics committee | National, provincial and municipal government research committees, UWC ethics committee |
Period of data collection | 2009 April-June | 2009 February- June | 2008 July- 2009 February | 2007 March- September; 2008 | 2008 September -2010 October |
2010 May | 2011 March- June | 2010 February-May | |||
2011 June-September | |||||
Language of data collection | Portuguese | French / Kirundi | English | Portuguese and English | English, Xhosa, Afrikaans, Zulu |
Number and type of interviews | National level: Ministry of Health (minister, advisors from the Ministry of Health / PAV-MINSA “immunization program”), and offices of selected Implementing Partners (UNICEF, ONUSIDA, EU, WHO) and NGOs 11 in 2009 1 in 2010 | National level: MoH officials (senior managers, HRH/ planning/ programs managers), National AIDS Council secretariat, NGOs representatives, GHIs representatives 27 in 2009 26 in 2011 | National level : in-depth key informant interviews with 22 representatives of the government, bilateral and multilateral development agencies and other stakeholders at the national level | National level: 21 in 2008; Ministry of Health (MoH) officials, offices of selected Implementing Partners (WHO, UNAIDS, UNICEF, Irish Aid, PMI/CDC, World Bank, USAID, CDC, DFID) and NGOs (MONASO-network of national NGOs working on AIDS, Malaria Consortium, Health Alliance International | National level: MoH officials, SANAC, international NGO coordinators, international health agencies coordinators 19 in 2008–2009 18 in 2010 |
Sub-national level: provincial government officers, NGOs, district managers, facility managers 30 in 2011 | Sub-national level: provincial government officers, provincial AIDS committee, NGOs, district managers, facility managers and employees 35 in 2009 45 in 2011 | Sub-national level: around 60 with provincial and district health directorates, HR managers, NGO managers, individuals in charge of health facilities and services responsible in 2010 | Sub-national levels: Provincial and municipal governments, sub-provincial management levels (general manager, HR manager, finance manager) N = 105 from 2009 to 2010 | ||
Facility and NGO level: NGO representative, health workers, facility manager N = 144 | |||||
Type of documents analyzed | National health policy, national programs of Malaria, Tuberculosis and Maternal Health and national and international reports; Published literature and unpublished documents provided by key informants of MINSA, national and international NGOs, Provincial Health Department and Municipal Hospitals. | Policy and planning documents from programs and HRH unit, national health plan, proposals for GHIs | Review of Lesotho’s Round 5 Grant Score Cards Grant Performance reports and policy and planning documents from programs and HRH unit, national plan : 10-15 | Policy and planning documents from National programs and HR National Directorate, national health plan, grey documents | Policy and planning documents from national department of health, grey documents, proposals for GHIs, draft policies |
Quantitative sampling method (sub-national level | NA | 3 provinces (2 rural and one urban, in each of which 3 or 4 facilities (NGO, private and public) were selected (14 in 2009 and 12 in 2011) | NA | NA | 3 provinces, minimum of 2 districts in each, minimum of two facilities in each district at lowest level providing ART initiation. Rural/urban sampling where possible at each level |
Type of quantitative data | HRH national report and national HIV program report for ART patients figures | Survey at facility level (N = 105 in 2009, N = 78 in 2011) to health workers (salary level, incentives, trainings, supervision) | NA | Surveys at facility level for HRH, infrastructures mapping, health information system, and pharmacy information; surveys for NGO mapping and district health services network | Health system trust database for HRH data; |
National ART report for ART patients number | |||||
Surveys at facility level for HRH number and trainings, surveys for NGO mapping and district health services network | |||||
HRH national review and national HIV program report for ART patients figures | |||||
Analysis method (software used) | Qualitative data: Thematic analysis - analyzed manually | Qualitative data: Framework analysis using Atlas.ti for | Qualitative data: Framework analysis using Atlas.ti | Qualitative data: Thematic analysis using Nvivo and content analysis | Qualitative data: Thematic analysis both manually and using Atlas.ti |
Quantitative data: analyzed using Stata (version 8) |
Results
Country contexts
Angola | Burundi | Lesotho | Mozambique | South Africa | |
---|---|---|---|---|---|
Significant historic features | Independence 1975 | Independence 1962 | Independence1966 | Independence: 1975 | Apartheid 1948-1994 |
Quarter century of civil war: 1975 - 2002 | Cyclic civil wars since 1963 | Several military coups with latest handover to democratic government in 1995 | Civil war: 1976-1992 | ||
Latest: 1993-2006 | |||||
Population density/km2 | 15 | 318 | 71 | 29 | 41 |
Net ODA as% of GNI | 0.3 | 42.3 | 5.4 | 20.8 | 0.4 |
GDP in current USD per capita | 4069 | 163 | 800 | 428 | 5733 |
Public health expenditure, as % of total government expenditure | 8 | 12 | 8 | 13 | 9 |
External resources for health, % of total expenditure for health | 3 | 45 | 30 | 72 | 2 |
OOP expenditure on health, % of total expenditure for health | 11 | 36 | 22 | 12 | 18 |
GINI coefficient (latest available) | 58.6 (2000) | 33.3 (2006) | 52.5 (2003) | 47.1 (2003) | 67.4 (2006) |
Human Development Index ranking 2011 (out of 187 countries) | 148 | 185 | 160 | 184 | 123 |
HIV prevalence 15–49 years old, % (2009) | 2 | 3.3 | 23.6 | 11.5 | 17.8 |
Number of persons affected by HIV, all ages, 2009 | 200,000 | 180,000 | 290,000 | 1,400,000 | 5,600,000 |
TB incidence, per 100,000 inhabitants, 2010 | 304 | 129 | 633 | 544 | 981 |
Number of TB cases detected, 2010 | 58,000 | 11,000 | 14,000 | 130,000 | 490,000 |
Malaria mortality rate per 100,000 inhabitants, 2008 | 89 | 39 | 0.1 | 171 | 0.2 |
Under-five mortality rate, per 1,000 live births, 2010 | 161 | 142 | 85 | 135 | 57 |
Maternal mortality ratio per 100,000 live births, 2008 | 610 | 970 | 530 | 550 | 410 |
GFATM-HIV, cumulative disbursement, as of 2011, millions USD | 62.2 | 69.5 | 91.8 | 168.7 | 247.6 |
GFATM-malaria, disbursed, as of 2011, millions USD | 62.0 | 55.2 | 0 | 61.6 | 0 |
GFATM-TB, disbursed, as of 2011, millions USD | 10.3 | 9.8 | 10.7 | 12.6 | 0 |
PEPFAR, disbursed, as of 2009, millions USD ( + committed 2010) | 47.7 | 0 (Not eligible) | 96.2 | 1096.7 | 3113.4 |
MAP1 World Bank, committed, millions USD | 21 | 51 (with MAP2) | 5 | 55 | 0 |
Year | Angola | Burundi | Lesotho | Mozambique | South Africa |
---|---|---|---|---|---|
2004 (unless otherwise specified) | 5,357 | 1,200 | 54,237 | 8,010 | 32,895 (2005) |
2009 (unless otherwise specified) | 20,640 | 17,500 (2010) | 92,773 (2008) | 134,147 | 781,465 |