Health systems and the implementation of disease programmes: case studies from South Africa

Glob Public Health. 2006;1(1):49-64. doi: 10.1080/17441690500361083.


This paper analyses the transfer and implementation of two internationally formulated infectious disease strategies in South Africa, namely, directly observed therapy (DOTS) for TB and syndromic management (SM) for sexually transmitted infections (STIs). Using the tools of policy analysis, this paper seeks to draw conclusions from contrasting experiences with the two strategies. DOTS and SM differ with respect to styles of engagement by World Health Organization (WHO), the international agency promoting the ideas, in the following ways: continuity and networking between policy makers, practitioners and researchers nationally; and approaches to sub-national implementation. We show how these factors may have been important to national uptake, and conclude on the need for a context sensitive approach to policy transfer and a balance between bottom-up and top-down implementation strategies. These insights may have relevance for the current global wave of treatment programmes for HIV and other infectious diseases.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS-Related Opportunistic Infections / prevention & control
  • Case Management*
  • Communicable Disease Control / methods*
  • Decision Making, Organizational
  • Diffusion of Innovation
  • Directly Observed Therapy*
  • Health Plan Implementation / organization & administration*
  • Health Policy
  • Humans
  • National Health Programs / organization & administration*
  • Organizational Case Studies
  • Policy Making
  • Program Development
  • Public Health Administration*
  • Sexually Transmitted Diseases / pathology
  • Sexually Transmitted Diseases / prevention & control*
  • South Africa
  • Syndrome
  • Tuberculosis / drug therapy
  • Tuberculosis / prevention & control*