A framework for providing integrated strategic information for the management of the antiretroviral treatment program in the Free State, South Africa
The AIDS epidemic, caused by Human Immunodeficiency Virus (HIV), is a global crisis which threatens development gains, economies, and societies. The eradication of HIV/AIDS represents one of humanity’s greatest challenges, which requires co-operation, and comprehensive collaboration between science, governments, social institutions, the media, the professions, and the general public. In this endeavour strategic information plays a major role. The Free State Department of Health introduced Antiretroviral Therapy (ART) to meet the needs of the rising number of people living with HIV and also dying due to AIDS related diseases. A patient information system was deployed by the Province to supplement the ART programme rollout process by gathering data and providing all the basic patient antiretroviral information. The patient information system was a traditional online clinical system and concentrated on the bread-and-butter issues of accumulating data on a patient. Very little functionality was provided to deal with the complexities of managing the clinical outcomes of the ART programme. To add to the problem, other online operational systems had to be interrogated to gain an understanding of the impact the rollout of ARV had. These operational systems ranged from standalone Human Resource systems to information systems accumulating data on tuberculosis which is closely related to HIV/AIDS. No mechanism or platform existed to provide management with integrated strategic information to manage the business process intelligently. This study focussed on the challenges and solutions to overcome this shortfall. The main objective of this study was to construct a framework for providing strategic information for the management of the ART programme in the Free State Department of Health. This objective was reached with a two phase action research methodology. The author of this study fulfilled simultaneously the roles of the researcher and the practitioner. During phase one a central data warehouse was designed and developed that incorporated an existing standalone ARV data warehouse and several other independent operational sources, all related to ART. This warehouse was evaluated by the users who overwhelmingly rated the warehouse as successful. From one system it was possible for managers to obtain strategic information on ARV encounters, ARV human resources, revenue collection, in-patient hospitalization, notifiable diseases and tuberculosis. This was achieved with a very limited budget and using internal resource. Although the data warehouse was a valuable asset by itself, several improvements were identified during the evaluation of the warehouse. The most important of these were to add additional data marts, to conform all the dimensions in order to obtain strategic information across the data marts and lastly to be able to track an ARV patient over time over all facilities of care. This led to the second phase of the research. In this phase several data marts (National Health Laboratory Services (NHLS), Meditech hospitalization and linkage to Home Affairs) were firstly added. Secondly the patient dimensions of all the data marts were conformed through the process of probabilistic record linkage. Lastly a longitudinal patient record was developed that displayed all the encounters of an ARV patient over time. Even though the LPR could not be scientifically evaluated, the institutions that did test it rated it very highly and reckoned it was a first for South Africa. This study, therefore, concluded with the fact that it was possible to construct and implement a successful framework for providing comprehensive strategic information for the management of the ART programme in the Free State Department of Health.