Vertical Interventions and Parallel Structures: A Case Study of the HIV and Tuberculosis Health Information Systems in South Africa

Abstract

South Africa is plagued by severe HIV and tuberculosis (TB) epidemics. Despite integration policies, health services’ reporting follows largely disease-specific vertical patterns, resulting in parallel data flows. This qualitative case study investigated how the health information system (HIS) is engaged with and perceived by health system employees. We conducted in-depth interviews with individuals (n=28) working in key roles at different levels of the health system in Cape Town, South Africa. Data from direct observation and document review complemented the interviews. All data were coded and analysed using thematic analysis. The key challenges reported included large amount of reporting in general, duplication of data elements, health governance and tensions over data collection tools. The vast amount of collected data was not considered holistic or fit-for-purpose. In conclusion, the HIS in South Africa causes work duplication and waste of efforts in times of scarce resources, and does not sufficiently support integration policies. Holistic approaches to studying, developing and implementing HIS are needed.