Politics of Tuberculosis and HIV programme Integration in Ghana

The need to integrate TB and HIV control programmes has become critical due to their interface at the clinical level and the need for optimal use of resources. In developing countries such as Ghana where public health interventions depend on donor funds, such calls have become more urgent than ever. But, its implementation depends on attitudes of implementers. This paper explores the views of stakeholders on tuberculosis and HIV integration in Ghana. Using a qualitative data collection approach, respondents were purposively selected from four regions with the highest reported tuberculosis cases. Two general views emerged: support for and opposition to integration. Supporters argued on shared clinical and social constructions and reducing financial and functional duplications. Those opposed cited increased workload, clinical complications, leadership crisis, and “smaller the better” arguments. Although a policy for TB/HIV integration exists, lack of clarity of direction and unwillingness of some programme managers to collaborate have resulted in disjointed health care for co-infected patients. Underlying the debate is an unspoken unwillingness of implementers to cede some or all-institutional “autonomy” for active, broad-based planning, implementation, monitoring and evaluation of programmatic goals.