Performance for Health through Focused Outputs, Results and Management (PERFORM)

In September 2012, Right to Care and the United States Agency for International Development (USAID) endorsed a bilateral cooperative agreement, known as Performance for Health through Focused Outputs, Results and Management (PERFORM).

Also referred to as the Health Systems Strengthening (HSS) programme, it encompassed three key objectives:

  • to improve HIV-related patient outcomes by strengthening health and patient management systems at facility, sub-district and district levels through capacity building and support,
  • to strengthen health systems in support of HIV-related services by working with provinces to build capacity of facility, sub-district and district management and
  • to provide support for the development and successful implementation of South African Government (SAG) policies for HIV-related interventions targeting governance, leadership and finance.

It was implemented in:

  • Free State – the Thabo Mofutsanyana district,
  • Mpumalanga – Ehlanzeni district and
  • Gauteng:
    • Johannesburg region A & B and
    • Tshwane sub-districts 3, 4 and 6.

With USAID as the key funder, the key strategic partner was the National Department of Health (NDoH). Our HSS programme staff worked with:

the NDoH

provincial, district and sub-district teams

healthcare staff in facilities

This programme concluded in September 2018.

Focus areas and beneficiaries

Key focus areas were:

adult and paediatric HIV care, treatment and support

maternal child health, prevention of mother to child transmission (PMTCT) and nutrition

sexual and reproductive health

TB screening, care and treatment

comprehensive prevention solutions

monitoring and evaluation (M&E)

pharmacy supply chain management

laboratory systems support

training and mentorship

health management improvement

Our HSS programme was aligned to the HIV treatment cascade model. This model focuses on the steps of care that people living with HIV go through – from diagnosis through to viral suppression.

The programme focused on helping:

people with HIV, TB and related infections- their families and communities

HIV negative individuals (for prevention)

The HSS programme saw Right to Care support the National Department of Health and the South African National AIDS Council (SANAC) with promoting healthcare in communities. The programme was aligned with the World Health Organization’s Health Systems Framework.

PERFORM/HSS programme achievements

  • Rapid increase in individuals tested for HIV and TB in facilities and communities
    • over 4,409,517 clients tested,
  • Enrolment and retention of 440,305 clients into antiretroviral treatment (ART) care,
  • Viral load suppression over 90% in all districts except Thabo Mofutsanyana,
  • Elimination of mother to child transmission targets achieved,
  • Decrease in the number of new HIV infections,
  • Expansion of life-saving services in a cost-efficient and sustainable way,
  • 100% digitalisation of data reporting,
  • Innovations for efficient drug delivery platforms,
  • HIV and TB research which changed HIV/TB management in South Africa,
  • Advocacy which influenced PEPFAR’s HIV/TB strategies and
  • Support of the health department’s pharmaceutical and supply chain management.

Performance towards 90-90-90 targets (2012 – 2018)

  • Cumulative HTS_TST – 4,409,517 (number of individuals who received HIV testing services and received test results)
  • Cumulative Tx_New – 415,659 (number of adults and children newly enrolled on antiretroviral therapy)
  • Cumulative Tx_Curr – 440,305 (number of adults and children currently receiving antiretroviral therapy)
  • Viral Load suppression as of September 2018 – 88%

“Through USAID funding during Right to Care’s PERFORM years, feasibility of epidemic control became a reality.” – Dr Pappie Majuba, Executive Director and Managing Director of RTC South Africa.

The viral load/CD4 dashboard

Partnership with the National Health Laboratory Service (NHLS(National Health Laboratory Service)) and Boston University

A dashboard to monitor the Comprehensive Care, Management and Treatment of HIV and AIDS (CCMT) programme was developed. It was used at national and provincial levels, as well as in districts and facilities. The dashboard tracks and visualises the CD4 count and viral load results of patients to help fast track achieving the UNAIDS 90-90-90 targets, especially at facility level.

Treating health seriously, caring, making treatment available in South Africa and abroad.

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