PDF(Pubmed)
Abstract：
UNASSIGNED: Translating health policy into effective implementation is a core priority for responding effectively to the tuberculosis (TB) crisis. The national TB Recovery Plan was developed in response to the negative impact that the COVID-19 pandemic had on TB care in South Africa. We aimed to explore the implementation of the TB Recovery Plan and develop recommendations for strengthening accountability for policy implementation for this and future TB policies.
UNASSIGNED: We interviewed 24 participants working on or impacted by TB policy implementation in South Africa. This included perspectives from national, provincial, and local health department representatives, civil society, and community representatives. In-depth interviews were conducted in English and isiXhosa and we drew on reflexive thematic methods for analysis.
UNASSIGNED: Participants felt that there was potential for COVID-19 innovations and urgency to influence TB policy development and implementation, including the use of data dashboards. Implementation of the TB Recovery Plan predominantly used a top-down approach to implementation (cascading from national policy to local implementers) but experienced bottlenecks at provincial level. Recommendations for closing the TB policy-implementation gap included using phased implementation and enhancing provincial-level accountability. Civil society organisations were concerned about the lack of provincial implementation data which impeded advocacy for improved accountability and inadequate resourcing for implementation. Community health workers were viewed as key to implementation but were not engaged in the policy development process and were often not aware of new TB policies. At local level, there were also opportunities to strengthen community engagement in policy implementation including through community-led monitoring. Participants recommended broader multi-stakeholder engagement that includes community and community health worker representatives in the development and implementation phases of new TB policies.
UNASSIGNED: Communities affected by TB, with the support of civil society organisations, could play a bigger role in monitoring policy implementation at local level and need to be capacitated to do this. This bottom-up approach could complement existing top-down strategies and contribute to greater accountability for TB policy implementation.
UNASSIGNED: The online version contains supplementary material available at 10.1186/s44263-024-00077-y.
UNASSIGNED: We interviewed 24 participants working on or impacted by TB policy implementation in South Africa. This included perspectives from national, provincial, and local health department representatives, civil society, and community representatives. In-depth interviews were conducted in English and isiXhosa and we drew on reflexive thematic methods for analysis.
UNASSIGNED: Participants felt that there was potential for COVID-19 innovations and urgency to influence TB policy development and implementation, including the use of data dashboards. Implementation of the TB Recovery Plan predominantly used a top-down approach to implementation (cascading from national policy to local implementers) but experienced bottlenecks at provincial level. Recommendations for closing the TB policy-implementation gap included using phased implementation and enhancing provincial-level accountability. Civil society organisations were concerned about the lack of provincial implementation data which impeded advocacy for improved accountability and inadequate resourcing for implementation. Community health workers were viewed as key to implementation but were not engaged in the policy development process and were often not aware of new TB policies. At local level, there were also opportunities to strengthen community engagement in policy implementation including through community-led monitoring. Participants recommended broader multi-stakeholder engagement that includes community and community health worker representatives in the development and implementation phases of new TB policies.
UNASSIGNED: Communities affected by TB, with the support of civil society organisations, could play a bigger role in monitoring policy implementation at local level and need to be capacitated to do this. This bottom-up approach could complement existing top-down strategies and contribute to greater accountability for TB policy implementation.
UNASSIGNED: The online version contains supplementary material available at 10.1186/s44263-024-00077-y.
摘要：
将卫生政策转化为有效实施是有效应对结核病（TB）危机的核心优先事项。国家结核病恢复计划是针对COVID-19大流行对南非结核病护理的负面影响而制定的。我们旨在探讨结核病恢复计划的实施情况，并提出建议，以加强对该结核病政策和未来结核病政策实施的问责制。
我们采访了24名参与南非结核病政策实施或受其影响的参与者。这包括来自国家的观点，省,和当地卫生部门的代表，公民社会,和社区代表。用英语和isiXhosa进行了深入访谈，我们采用了反身性主题方法进行分析。
与会者认为，COVID-19创新的潜力和紧迫性影响结核病政策的制定和实施，包括数据仪表板的使用。结核病恢复计划的实施主要采用自上而下的实施方法（从国家政策到地方实施者的级联），但在省一级遇到了瓶颈。缩小结核病政策执行差距的建议包括分阶段实施和加强省级问责制。民间社会组织对缺乏省级执行数据感到关切，这阻碍了倡导改善问责制和执行资源不足。社区卫生工作者被视为实施的关键，但没有参与政策制定过程，而且往往不了解新的结核病政策。在地方一级,还有机会加强社区对政策执行的参与，包括通过社区主导的监测。与会者建议更广泛的多方利益攸关方参与，包括社区和社区卫生工作者代表参与新结核病政策的制定和实施阶段。
■受结核病影响的社区，在民间社会组织的支持下，可以在监测地方一级的政策执行方面发挥更大的作用，需要有能力做到这一点。这种自下而上的方法可以补充现有的自上而下的战略，并有助于加强结核病政策实施的问责制。
■在线版本包含补充材料，可在10.1186/s44263-024-00077-y获得。
我们采访了24名参与南非结核病政策实施或受其影响的参与者。这包括来自国家的观点，省,和当地卫生部门的代表，公民社会,和社区代表。用英语和isiXhosa进行了深入访谈，我们采用了反身性主题方法进行分析。
与会者认为，COVID-19创新的潜力和紧迫性影响结核病政策的制定和实施，包括数据仪表板的使用。结核病恢复计划的实施主要采用自上而下的实施方法（从国家政策到地方实施者的级联），但在省一级遇到了瓶颈。缩小结核病政策执行差距的建议包括分阶段实施和加强省级问责制。民间社会组织对缺乏省级执行数据感到关切，这阻碍了倡导改善问责制和执行资源不足。社区卫生工作者被视为实施的关键，但没有参与政策制定过程，而且往往不了解新的结核病政策。在地方一级,还有机会加强社区对政策执行的参与，包括通过社区主导的监测。与会者建议更广泛的多方利益攸关方参与，包括社区和社区卫生工作者代表参与新结核病政策的制定和实施阶段。
■受结核病影响的社区，在民间社会组织的支持下，可以在监测地方一级的政策执行方面发挥更大的作用，需要有能力做到这一点。这种自下而上的方法可以补充现有的自上而下的战略，并有助于加强结核病政策实施的问责制。
■在线版本包含补充材料，可在10.1186/s44263-024-00077-y获得。
