‘We had to manage what we had on hand, in whatever way we could’: Adaptive responses in policy for decentralized drug-resistant tuberculosis care in South Africa
Abstract
In 2011, the South African National TB Programme launched a policy of decentralized management
of drug-resistant tuberculosis (DR-TB) in order to expand the capacity of facilities to treat patients
with DR-TB, minimize delays to access care and improve patient outcomes. This policy directive
was implemented to varying degrees within a rapidly evolving diagnostic and treatment landscape
for DR-TB, placing new demands on already-stressed health systems. The variable readiness of
district-level systems to implement the policy prompted questions not only about differences in
health systems resources but also front-line actors’ capacity to implement change in resourceconstrained facilities.