Dual indices for prioritizing investment in decentralized HIV services at Nigerian primary health care facilities

Abstract

Decentralizing health services, including those for HIV prevention and treatment, is one strategy for maximizing the use of limited resources and expanding treatment options; yet few methods exist for systematically identifying where investments for service expansion might be most effective, in terms of meeting needs and rapid availability of improved services. The Nigerian Government, the United States Government under the President's Emergency Plan for AIDS Relief (PEPFAR) program and other donors are expanding services for prevention of mother-to-child transmission (PMTCT) of HIV to primary health care facilities in Nigeria. Nigerian primary care facilities vary greatly in their readiness to deliver HIV/AIDS services. In 2012, MEASURE Evaluation assessed 268 PEPFAR-supported primary health care facilities in Nigeria and developed a systematic method for prioritizing these facilities for expansion of PMTCT services. Each assessed facility was scored based on two indices with multiple, weighted variables: one measured facility readiness to provide PMTCT services, the other measured local need for the services and feasibility of expansion. These two scores were compiled and the summary score used as the basis for prioritizing facilities for PMTCT service expansion. The rationale was that using need and readiness to identify where to expand PMTCT services would result in more efficient allocation of resources. A review of the results showed that the indices achieved the desired effect—that is prioritizing facilities with high need even when readiness was problematic and also prioritizing facilities where rapid scale-up was feasible. This article describes the development of the two-part index and discusses advantages of using this approach when planning service expansion. The authors' objective is to contribute to development of methodologies for prioritizing investments in HIV, as well as other public health arenas, that should improve cost-effectiveness and strengthen services and systems in resource-limited countries.

Challenges of primary healthcare nurses regarding the integration of HIV and AIDS services into primary healthcare in Vhembe district of Limpopo province, South Africa

“…Various strategies such as task-shifting were, therefore, introduced in countries with severe human resources shortages. Task-shifting involves redistributing of selected tasks from physicians to adequately trained nurses and from nurses to adequately trained lower-level health workers or lay providers (Fronczak et al 2015 ).…”

Challenges of primary healthcare nurses regarding the integration of HIV and AIDS services into primary healthcare in Vhembe district of Limpopo province, South Africa

“…Various strategies such as task-shifting were, therefore, introduced in countries with severe human resources shortages. Task-shifting involves redistributing of selected tasks from physicians to adequately trained nurses and from nurses to adequately trained lower-level health workers or lay providers (Fronczak et al 2015).…”

Prevention of Mother-to-Child Transmission of HIV in Delta State of Nigeria: Evaluation of the Early Infant Diagnosis Program

“…Second is the level of negative results (i.e., efficiency).While 4.4% of infants on ART tested positive at first test with indication of reduction at 18 th month (Table 2), up to 83% of the subpopulation of 'mother-and-child' who were suspected to miss early start of PMTCT (i.e., indicated by not being on ART) tested positive at both initial and 18 th month tests. Other studies have previously acknowledged or implied the effectiveness of PMTCT services in Nigeria [33][34][35][36] , and availability of the service in Delta State 16 . What this report adds to the body of literature is evidence of efficiency of the EID program in Delta State.…”