Assessment of the constraints to effective delivery of HIV prevention, treatment and care services in a resource-limited setting
Main Article Content
Abstract
Background: Scaling up HIV prevention, treatment and care services may face a number of constraints. Project constraint is a barrier to full potential.
Objectives: This study assessed the constraints to effective delivery of HIV prevention, treatment and care services and made recommendations for improvement in resource-limited settings.
Methods: In a cross sectional study, study-specific questionnaires were self-administered to 90 out of 104 health workers providing HIV services and 150 out of 200 HIV-positive patients in seven public health facilities in Edo State, Nigeria. Participants were selected using simple random sampling. Chi square was used for inferential statistics; and P values were two-tailed at 95% confidence interval.
Results: Of the health workers, 59.2% were males, 39.4% aged 31–40 years old, 22.5% doctors, 14.1% pharmacists, 15.5% laboratory scientists, 33.8% nurses, 7.0% record officers, and 7.0% administrators. Of the clients, 55.2% were females, 39.7% aged 31–40 years old; majority (40.5%) had accessed services in the facilities for 1–3 years and 29.3% accessed for 3–6 months prior to this study. Major constraints reported by health workers included inadequate health workforce (24.5%), lack of government ownership (14.9%), lack of incentives/staff motivation(13.8%), and poor working conditions(12.8%); whereas clients reported inadequate health workforce(41.4%), long waiting time (21.4%), stock-out or inadequate supply of drugs, reagents and materials (7.1%). Stigmatization by health workers was reported by 17.6% of clients. Major recommendations by health workers for improvement included recruitment of additional health workforce (36.4%), improved working conditions (15.2%), good staff motivation/incentives (15.2%); whereas clients recommended recruitment of additional health workforce (54.3%), reduced waiting time (13.0%) and improved working conditions (7.6%). However, there was no association between effective delivery of HIV interventions and staff motivation (P=0.0571).
Conclusions: The major constraints reported were inadequate health workforce, lack of government ownership and poor working conditions. Recruitment of additional health workforce and improved working conditions were the major recommendations for improved delivery of quality of HIV interventions.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
UNAIDS/WHO (2013). Global AIDS Epidemic Update. Available at: http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2013/gr2013/UNAIDS_Global_Report_2013_en.pdf,Accessed 1st April 2014.
UNAIDS/WHO (2007). AIDS Epidemic Update. Available at: http://data.unaids.org/pub/epislides/2007/2007_epiupdate_en.pdf, Accessed 1st April 2014.
World Health Organization (2008). Essential Prevention and Care Interventions for Adults and Adolescents living with HIV in resource-limitedsettings. Available at: http://www.who.int/hiv/pub/prev_care/OMS_EPP_AFF_en.pdf, Accessed 1st April 2014.
World Health Organization (2007). Towards universal access: scaling up priority HIV/AIDS interventions in the health sector: progress
report. Available at:http://www.who.int/hiv/mediacentre/universalst_access_progress_report_en.pdf, Accessed 1 April 2014
Federal Ministry of Health (2014). Integrated National Guidelines for HIV Prevention, Treatment and Care. Federal Ministry of Health, Abuja 2014.
Hanson, K., Ranson, M. K., Oliveira-Cruz, V. and Mills, A (2003). Expanding access to priority health interventions: a framework for understanding the constraints to scaling-up. J. Int. Dev 15: 1–14.
World Health Organization (2004). Scaling up HIV/AIDS care: service delivery and human resources perspectives. World Health
Organization, Geneva. Available at: http://www.who.int/hrh/documents/en/HRH_AstRT_paper.pdf. Accessed 1 April 2014.
Jones D, Weiss S, Chitalu N (2014). HIV Prevention in Resource Limited Settings: A Case Study of Challenges and Opportunities for
Implementation. Int J Behav Med. DOI: 10.10007/s12529-014-9397-3.
Chillag K, Bartholow K, Cordeiro J, Swanson S, Patterson J, Stebbins S, Woodside C, Sy F (2002). Factors Affecting the Delivery of HIV/AIDS
Prevention Programs by Community-Based Organizations. AIDS Education and Prevention 14, Supplement A, 27–37.
Nunnally JC (1978). Psychometric Theory. McGraw-Hill, Inc.: New York, 1978.
Offiong OJ. (2004). Frederick Herzberg. In: Nnamdi HS, Offiong OJ, Tonwe DA (Eds.), Eminent Administrative and Management Thinkers, 3rd Edition. Amfitop, Lagos, pp. 226 - 238.
Scott S (1975). Behavioural Theories. In: Scott S (Ed), Behavioural Theories. Coverdale Educational Publishers. London, pp. 3 - 65
Schwab DP, Devitt WH, Cummings LI (1971). A testof the adequacy of the two factor theory as a predictor of self-report performance effects personnel psychology. Summer 293 - 303.
Tonwe DA (2004). George Elton Mayo. In: Nnamdi HS, Offiong OJ, Tonwe DA (Eds.), Eminent Administrative and Management Thinkers, 3rd
Edition. Amfitop, Lagos, pp. 194 - 208.