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The politics of tuberculosis and HIV service integration in Ghana

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  • Amo-Adjei, Joshua
  • Kumi-Kyereme, Akwasi
  • Fosuah Amo, Hannah
  • Awusabo-Asare, Kofi

Abstract

The need to integrate TB/HIV control programmes has become critical due to the comorbidity regarding these diseases and the need to optimise the use of resources. In developing countries such as Ghana, where public health interventions depend on donor funds, the integration of the two programmes has become more urgent. This paper explores stakeholders' views on the integration of TB/HIV control programmes in Ghana within the remits of contingency theory. With 31 purposively selected informants from four regions, semi-structured interviews and observations were conducted between March and May 2012, and the data collected were analysed using the inductive approach. The results showed both support for and opposition to integration, as well as some of the avoidable challenges inherent in combining TB/HIV control. While those who supported integration based their arguments on clinical synergies and the need to promote the efficient use of resources, those who opposed integration cited the potential increase in workload, the clinical complications associated with joint management, the potential for a leadership crisis, and the “smaller the better” propositions to support their stance. Although a policy on TB/HIV integration exists, inadequate ‘political will’ from the top management of both programmes has trickled down to lower levels, which has stifled progress towards the comprehensive management of TB/HIV and particularly leading to weak data collection and management structures and unsatisfactory administration of co-trimoxazole for co-infected patients. It is our view that the leadership of both programmes show an increased commitment to protocols involving the integration of TB/HIV, followed by a commitment to addressing the ‘fears’ of frontline service providers to encourage confidence in the process of service integration.

Suggested Citation

  • Amo-Adjei, Joshua & Kumi-Kyereme, Akwasi & Fosuah Amo, Hannah & Awusabo-Asare, Kofi, 2014. "The politics of tuberculosis and HIV service integration in Ghana," Social Science & Medicine, Elsevier, vol. 117(C), pages 42-49.
    • Handle: RePEc:eee:socmed:v:117:y:2014:i:c:p:42-49
    DOI: 10.1016/j.socscimed.2014.07.008
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    References listed on IDEAS

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    1. Daftary, Amrita, 2012. "HIV and tuberculosis: The construction and management of double stigma," Social Science & Medicine, Elsevier, vol. 74(10), pages 1512-1519.
    2. GROTSCH, Volker M. & BLOME, Constantin & SCHLEPER, Martin C., 2013. "Antecedents of proactive supply chain risk management - a contingency theory perspective," LIDAM Reprints CORE 2490, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
    3. Dodor, Emmanuel Atsu & Kelly, Shona J., 2010. "Manifestations of tuberculosis stigma within the healthcare system: The case of Sekondi-Takoradi Metropolitan district in Ghana," Health Policy, Elsevier, vol. 98(2-3), pages 195-202, December.
    4. Ogden, Jessica & Walt, Gill & Lush, Louisiana, 2003. "The politics of 'branding' in policy transfer: the case of DOTS for tuberculosis control," Social Science & Medicine, Elsevier, vol. 57(1), pages 179-188, July.
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    Cited by:

    1. Prince Justin Anku & Joshua Amo-Adjei & David Doku & Akwasi Kumi-Kyereme, 2020. "Challenges of scaling-up of TB-HIV integrated service delivery in Ghana," PLOS ONE, Public Library of Science, vol. 15(7), pages 1-14, July.

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