Health Systems and Access to Antiretroviral Drugs for HIV in Southern Africa: Service Delivery and Human Resources Challenges

Schneider, Helen; Blaauw, Duane; Gilson, Lucy; Chabikuli, Nzapfurundi; Goudge, Jane

doi:10.1016/s0968-8080(06)27232-x

Cited by 179 publications

(153 citation statements)

References 22 publications

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“…25 Indeed, they often contribute to the deterioration of the public health system insofar as they divert financial and human resources from the government health sector when they could be feeding funds through it. 26,27 The current patchwork of services places an undue burden on those requiring care to seek it at multiple sites. While there is a growing focus on the importance of continuous and integrated care, which recognizes the failure of vertical programmes, and the importance of social determinants of health, these theoretical and policy shifts have been slow to materialize in programmes.…”

Section: Discussionmentioning

confidence: 99%

Women’s expectations of treatment and care after an antenatal HIV diagnosis in Lilongwe, Malawi

Levy

2009

Reproductive Health Matters

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Section: Discussionmentioning

confidence: 99%

Women’s expectations of treatment and care after an antenatal HIV diagnosis in Lilongwe, Malawi

Levy

2009

Reproductive Health Matters

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“…The importance of addressing human resources for health constraints in order to attain ART scale-up targets in resource-limited settings is consistent in the literature [22,49,58]. However, there are mounting calls for funders of public health interventions to adopt ‘whole-of-system’ approaches which utilize ‘systems thinking’ as opposed to fragmented approaches which focus on individual building blocks of the health system [25,44,45,59].…”

Section: Discussionmentioning

confidence: 93%

Assessing the level of institutionalization of donor-funded anti-retroviral therapy (ART) programs in health facilities in Uganda: implications for program sustainability

Zakumumpa

Kwiringira

Rujumba

et al. 2018

Global Health Action

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Background: In the context of declining international assistance for ART scale-up in Sub-Saharan Africa, the institutionalization of ART programs through integrating them in the organizational routines of health facilities is gaining importance as a program sustainability strategy. Objective: The aims of this study were; (i) to compare the level of institutionalization of ART programs in health facilities in Uganda and (ii) to explore reasons for variations in the degree of program institutionalization. Methods: In Phase One, we utilized Level of Institutionalization Scales developed by Goodman (1993) to measure the degree of institutionalization of ART interventions in 195 health facilities across Uganda. The 45-item questionnaire measured institutionalization based on four sub-systems (production, maintenance, supportive, managerial) theorized to make up an organization assessed against two levels of institutionalization; routines (lowest) niche saturation (highest). In Phase Two, four health facilities were purposively selected (2 with the highest and 2 with the lowest institutionalization scores) for a multiple case-study involving semi-structured interviews with ART clinic managers(n = 32), on-site observations and document review. Results: The two highest scoring health facilities had a longer HIV intervention implementation history of between 8 and 11 years. The highest scoring cases associated intervention institutionalization with sustained workforce trainings in ART management, the retention of ART-trained personnel and generating in-house ART manuals. The turnover of ART-proficient staff was identified as a barrier to intervention institutionalization in the lowest-ranked cases. Significant differences in organizational contexts were identified. The two highest-ranked health facilities were well-established, higher-tier hospitals while the lowest scoring health facilities were lower-level health facilities. Conclusions: The level of institutionalization of ART interventions appeared to be differentiated by level of care in the Ugandan health system. Interventions aimed at strengthening program institutionalization in lower-level health centers at the level of human resources for health could enhance ART scale-up sustainability.

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“…Some may also feel poorly trained and lack the confidence to handle the epidemic or share in the stigma that surrounds it. 11,21,[23][24][25] Primary care nurses work under extremely difficult conditions, with little support, often without the necessary drugs and equipment, and with a large numbers of ill patients. They may have little influence over their working conditions, which may make them feel disempowered.…”

Section: Discussionmentioning

confidence: 99%

“…In the public sector in South Africa there is currently a severe shortage of professional staff, which heavily impacts on the ability of health facilities and services to offer adequate HIV care and treatment. 21 This study was conducted at a typical rural district hospital in the Limpopo Province of South Africa. In Limpopo, about 20% of pregnant women test positive for HIV, and, in 2001, out of 27 000 children estimated to have HIV only 2 500 were receiving ART.…”

Section: Introductionmentioning

confidence: 99%

How children access antiretroviral treatment at Kgapane District Hospital, Limpopo, South Africa

Railton

Mash

2012

South African Family Practice

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Background: At Kgapane Hospital, Limpopo Province, only 20% of eligible children initiated antiretroviral treatment (ART) in 2007. The aim of this study was to improve the ART programme by assessing how children were accessing ART, and to explore the factors that facilitate or obstruct this access.Method: Mixed methods were used in a descriptive study of human immunodeficiency virus (HIV)-infected children admitted to the hospital over a seven-month period and their caregivers. Children's subsequent attendance for ART was tracked and caregivers were interviewed about factors influencing access and attendance.Results: Of 132 children initially admitted, 14 (10.6%) subsequently died and 13 (9.8%) relocated. Sixty of the remaining 105 (57.1%) returned within one month to the antiretroviral clinic, three (2.9%) attended later and 42 (40.0%) did not return at all. Quantitative data associated with poor attendance were younger age, higher CD4 count, maternal caregiver, no income and participation in the prevention of mother-to-child transmission program. Qualitative factors included a lack of money for transport, poor social support, and mothers who struggled to accept their diagnosis, had poor understanding of HIV and strong traditional beliefs. Primary care providers delayed HIV testing and referral, displayed poor attitudes, and were insufficient in number. Quantitative factors significantly associated with good attendance were prior knowledge of the child/mother's HIV status, mother's ART treatment and referral to the dietician. Conclusion:There are serious deficiencies in the prevention, diagnosis and treatment of HIV in children. Factors were identified to improve health services and these highlight the need for broader strategies aimed at addressing poverty, stigma and education.Peer reviewed.

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Health Systems and Access to Antiretroviral Drugs for HIV in Southern Africa: Service Delivery and Human Resources Challenges

Cited by 179 publications

References 22 publications

Women’s expectations of treatment and care after an antenatal HIV diagnosis in Lilongwe, Malawi

Women’s expectations of treatment and care after an antenatal HIV diagnosis in Lilongwe, Malawi

Assessing the level of institutionalization of donor-funded anti-retroviral therapy (ART) programs in health facilities in Uganda: implications for program sustainability

How children access antiretroviral treatment at Kgapane District Hospital, Limpopo, South Africa

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