Shifting human resources for health in the context of ART provision: qualitative and quantitative findings from the Lablite baseline study

Abstract

BackgroundLablite is an implementation project supporting and studying decentralized antiretroviral therapy (ART) rollout to rural communities in Malawi, Uganda and Zimbabwe. Task shifting is one of the strategies to deal with shortage of health care workers (HCWs) in ART provision. Evaluating Human Resources for Health (HRH) optimization is essential for ensuring access to ART. The Lablite project started with a baseline survey whose aim was to describe and compare national and intercountry delivery of ART services including training, use of laboratories and clinical care.MethodsA cross-sectional survey was conducted between October 2011 and August 2012 in a sample of 81 health facilities representing different regions, facility levels and experience of ART provision in Malawi, Uganda and Zimbabwe. Using a questionnaire, data were collected on facility characteristics, human resources and service provision. Thirty three (33) focus group discussions were conducted with HCWs in a subset of facilities in Malawi and Zimbabwe.ResultsThe survey results showed that in Malawi and Uganda, primary care facilities were run by non-physician clinical officers/medical assistants while in Zimbabwe, they were run by nurses/midwives. Across the three countries, turnover of staff was high especially among nurses. Between 10 and 20% of the facilities had at least one clinical officer/medical assistant leave in the 3 months prior to the study. Qualitative results show that HCWs in ART and non-ART facilities perceived a shortage of staff for all services, even prior to the introduction of ART provision. HCWs perceived the introduction of ART as having increased workload. In Malawi, the number of people on ART and hence the workload for HCWs has further increased following the introduction of Option B+ (ART initiation and life-long treatment for HIV positive pregnant and lactating women), resulting in extended working times and concerns that the quality of services have been affected. For some HCWs, perceived low salaries, extended working schedules, lack of training opportunities and inadequate infrastructure for service provision were linked to low job satisfaction and motivation.ConclusionsART has been decentralized to lower level facilities in the context of an ongoing HRH crisis and staff shortage, which may compromise the provision of high-quality ART services. Task shifting interventions need adequate resources, relevant training opportunities, and innovative strategies to optimize the operationalization of new WHO treatment guidelines which continue to expand the number of people eligible for ART.

A qualitative exploration among the staff of an antiretroviral therapy center in (central) India regarding factors associated with job satisfaction, patient satisfaction and treatment success

“…42 In order to optimize the operationalization of the latest guidelines for ART, in addition to adequate resources, relevant training opportunities, and innovative strategies are needed. 25 Similar to the findings of the present study, a previous study in India has also reported willingness and interest of the staff and students about participation in training programmes which enable the service providers in providing better and more efficient treatment to HIV/AIDS patients. 43 Education and training programs strengthen HIV/AIDS care, prevention, treatment and management skills among healthcare professionals, addressing problems such as HIV Drug Resistance (HIVDR).…”

“…Similar to our findings, in a previous study, health care workers expressed concern about increased workload resulting from the expansion of the ART eligibility. 25 Foregoing issue is closely related to job-satisfaction and motivation. Participants in our study brought up several personal needs in this connection, mentioned stress and discussed short duration of stay of some of the functionaries at the center (Table 2).…”

“…27 Concerns such as low salaries, extended working schedules, lack of training opportunities and inadequate infrastructure for service provision have been documented as linked to low job-satisfaction and motivation. 25 In a recent qualitative study from (south) India, job-perception of counselors was explored. Their study found poor job-satisfaction along with problems related to the pay scale and shared confidentiality, refresher training and targets set for counseling and testing.…”

Evaluation of the impact of the ARC program on national nursing and midwifery regulations, leadership, and organizational capacity in East, Central, and Southern Africa

“…In sub-Saharan Africa, an estimated seven million people living with HIV still need antiretroviral treatment (ART) if targets set by the United Nations Joint Program on HIV and AIDS are to be reached [ 1 – 3 ]. Studies from numerous countries in sub-Saharan Africa have demonstrated that nurses and midwives can provide safe and effective HIV care and treatment [ 4 – 12 ]. The World Health Organization (WHO) recommends nurse initiated and managed ART (NIMART) to increase ART coverage [ 13 ].…”

A multi-site community randomized trial of community health workers to provide counseling and support for patients newly entering HIV care in rural Ethiopia: study design and baseline implementation

“…Such assistance may be particularly beneficial in rural areas, where HIV clinics with limited numbers of skilled health personnel are facing a growing volume of patients as a result of decentralization of HIV care to peripheral health facilities, as well as increasing numbers of PLWH due to improved life expectancy from ART and other treatment advances [20–24]. …”