The primary aim of UKZN's 20,000 + project was achievement of the elimination of PMTCT- a goal of the NSP. A health system strengthening approach, using Continuous Quality Improvement is used to achieve this goal. The project will be supporting the Office of Standards Compliance to assess facilities, and use the Quality Improvement approach to address gaps identified. This is the first step in working towards the implementation of the National Health Insurance model. UKZN is also developing leadership skills in the usage of data, and improving monitoring and evaluation of programmes. They are also evaluating the usage of QI methodology to improve the supervision of community care givers in collaboration with WHO. They are working in all districts in the Kwa Zulu Natal province. At 3 of the districts, UKZN works at facility level. They are integrating the TB and HIV programs in the PMTCT program, as TB has been found to be one of the leading causes of maternal deaths in HIV-infected mothers. Although they are primarily focusing on maternal and child health, they are also developing overall skills of information officers in data management. Training has also been held for monitoring and evaluation of programs. Using task- shifting and improving process flow in facilities is contributing to improved efficiency of service delivery within existing resources. Health systems are also strengthened by the project staff that bring together skills from clinics and hospitals. They have purchased 4 vehicles, and plan to purchase 2 more to extend the scope and geographic coverage.

Attention will be given to the training of health care workers in improving data management systems. This is in keeping with the PHC re-engineering process which seeks to improve monitoring and evaluation activities across the country. The 20 000+ partnership project has been requested by the Department of Health to extend its work across the province. In addition, the project is leading a process of developing a monitoring framework for the new infant and young children feeding policy that was launched in KZN in January 2011.The province has pioneered the implementation of the 2010 WHO guidelines on the topic of infant feeding in the context of HIV. The project is also testing data elements and reporting to the province regularly on barriers and facilitators of policy implementation.A data-focused approach is being used, which is the building block that has to be in place to achieve good data quality. To this end, the focus will be on training facility and district information officers, and monitoring and evaluation managers in the use of data and information to guide improvement and identify gaps in programme performance. District leadership teams will be trained in this area. The National Department of Health will also use a 'dashboard' of measures for every district to focus on. The 20 000+ partnership project will build capacity in district leadership to monitor this dashboard particularly in the area of maternal, child, and women's health.

This strategic programme has been the building block of 20 000+ partnership projects work. The methodology used by the programme was subsequently used in the National Accelerated PMTCT programme in 2009. The improvement noted in the performance of the PMTCT programme across KwaZulu Natal province has been noted nationally, and best practices are being scaled up. As result of the projects work, there has been additional attention paid to data quality nationally, as a data-focused approach to quality improvement is being used. Capacity is being built in facility and district information officers across the province. District leadership teams are also using routine health information to improve programme performance by identifying gaps. Targets set for HIV counseling and testing have been set at 95%, and this target is being achieved in KZN by task -shifting, process changes in facilities and data usage at facility level. The target for access to ART was set at 80%, and in some districts e.g. Ugu, 100% has been achieved. The target for PCR testing at 6 weeks was set at 90% and already close to 80% of infants is being tested. The recent impact evaluation done by MRC has indicated that the transmission rate in KZN has decreased from 20% to 2.8%. The challenge is now to sustain this improvement. Capacity is being built in health care workers to sustain this improvement by strengthening links with the district programme managers and the referral hospitals, as they share data on programme performance. Managers are being trained in quality improvement, and are leading meetings in the 3 districts in which the 20 000+ project works, thereby ensuring sustained improvement. Best practices are shared and scaled up at collaborative meetings. Work is being done with community care givers to increase early booking and post natal visits. The project is also working closely with other partners and programmes e.g. nutrition testing the implementation of the new infant and young child feeding policy, and informs the department on its progress. The National Department of Health is taking its lead from the lessons learnt in KZN. The project aims to improve the 18 month HIV testing of infants from the existing 30% to 80% in the next year, as well as improve on child survival.