This story originally appeared in IHI's 2007 Annual Progress Report.
Situated just south of Mozambique and just east of Swaziland, Umkhanyakude District in South Africa is a remote rural area, lacking in resources but filled with innovative ideas and a desire to improve health care.
In partnership with the Center for Rural Health (University of KwaZulu-Natal) and IHI, this District has doubled the number of people initiated on antiretroviral treatment for HIV during each of the last two years. As a result, the District leads the nation in primary care-based HAART, and is well ahead of the national standard rate of annual new HAART initiations. Its goal is more ambitious still: to have all people on treatment who require it by the end of 2007.
A pre-existing loose-knit network of hospitals in the District was galvanized through a Breakthrough Series Collaborative
to set aims, identify roadblocks to those aims, and change the health system through testing and reflection. Staff tested and implemented changes
that reduced the time from HIV diagnosis to HAART initiation. Changes included bundling of testing services; streamlined literacy and adherence training; and provision of care at the local clinic. Without additional physical or human resources, this District greatly increased its ability to identify people in need of treatment while also increasing its capacity to treat those people at a primary care level.