A qualitative exploration of the human resource policy implications of voluntary counselling and testing scale-up in Kenya: applying a model for policy analysis

Taegtmeyer, Miriam; Martineau, Tim; Namwebya, Jane Harriet; Ikahu, Annrita; Ngare, Carol; Sakwa, J.S.; Lalloo, David G.; Theobald, Sally

doi:10.1186/1471-2458-11-812

Cited by 16 publications

(13 citation statements)

References 24 publications

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“…Similar findings in research on anaemia management in ANC in East Java [2] suggest this may be relevant to other areas across Indonesia. Evidence from other contexts supports the hints in our data that potential obstacles within regulation, personnel roles and training are in politics with laboratory staff in relation to task-shifting, and in ensuring equity even in outreach areas [54][55][56]. Operational research alongside political prioritisation has been shown to inform and facilitate interventions in staff training and supervision, both identified as needs in our study, leading to improved antenatal testing rates [57].…”

Section: Discussionsupporting

confidence: 79%

Antenatal testing for anaemia, HIV and syphilis in Indonesia – a health systems analysis of low coverage

Baker

Limato

Tumbelaka

et al. 2020

BMC Pregnancy Childbirth

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Background: Adverse pregnancy outcomes can be prevented through the early detection and treatment of anaemia, HIV and syphilis during the antenatal period. Rates of testing for anaemia, HIV and syphilis among women attending antenatal services in Indonesia are low, despite its mandate in national guidelines and international policy. Methods: Midwife-held antenatal care records for 2015 from 8 villages in 2 sub-districts within Cianjur district were reviewed, alongside the available sub-district Puskesmas (Community Health Centre) maternity and laboratory records. We conducted four focus group discussions with kaders (community health workers) (n = 16) and midwives (n = 9), and 13 semi-structured interviews with laboratory and counselling, public sector maternity and HIV management and relevant non-governmental organisation staff. Participants were recruited from village, subdistrict, district and national level as relevant to role. Results: We were unable to find a single recorded result of antenatal testing for HIV, syphilis or anaemia in the village (566 women) or Puskesmas records (2816 women) for 2015. Laboratory records did not specifically identify antenatal women. Participants described conducting and reporting testing in a largely ad hoc manner; relying on referral to health facilities based on clinical suspicion or separate non-maternity voluntary counselling and testing programs. Participants recognized significant systematic challenges with key differences between the more acceptable (and reportedly more often implemented) haemoglobin testing and the less acceptable (and barely implemented) HIV and syphilis testing. However, a clear need for leadership and accountability emerged as an important factor for prioritizing antenatal testing and addressing these testing gaps. Conclusions: Practical solutions such as revised registers, availability of point-of-care tests and capacity building of field staff will therefore need to be accompanied by both funding and political will to coordinate, prioritize and be accountable for testing in pregnancy.

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Section: Discussionsupporting

confidence: 79%

Antenatal testing for anaemia, HIV and syphilis in Indonesia – a health systems analysis of low coverage

Baker

Limato

Tumbelaka

et al. 2020

BMC Pregnancy Childbirth

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“…A summary of draft findings was additionally circulated within the ZPS to garner feedback. Our approach was guided by recognized qualitative analysis techniques including reading for content, coding, data reduction, data display and interpretation ( Yin 2009 ; Cataldo et al 2011 ; Taegtmeyer et al 2011 ) .…”

Section: Methodsmentioning

confidence: 99%

Exploring the drivers of health and healthcare access in Zambian prisons: a health systems approach

Topp

Moonga

Luo

et al. 2016

Health Policy Plan.

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Background Prison populations in sub-Saharan Africa (SSA) experience a high burden of disease and poor access to health care. Although it is generally understood that environmental conditions are dire and contribute to disease spread, evidence of how environmental conditions interact with facility-level social and institutional factors is lacking. This study aimed to unpack the nature of interactions and their influence on health and healthcare access in the Zambian prison setting.Methods We conducted in-depth interviews of a clustered random sample of 79 male prisoners across four prisons, as well as 32 prison officers, policy makers and health care workers. Largely inductive thematic analysis was guided by the concepts of dynamic interaction and emergent behaviour, drawn from the theory of complex adaptive systems.Results A majority of inmates, as well as facility-based officers reported anxiety linked to overcrowding, sanitation, infectious disease transmission, nutrition and coercion. Due in part to differential wealth of inmates and their support networks on entering prison, and in part to the accumulation of authority and material wealth within prison, we found enormous inequity in the standard of living among prisoners at each site. In the context of such inequities, failure of the Zambian prison system to provide basic necessities (including adequate and appropriate forms of nutrition, or access to quality health care) contributed to high rates of inmate-led and officer-led coercion with direct implications for health and access to healthcare. Conclusions This systems-oriented analysis provides a more comprehensive picture of the way resource shortages and human interactions within Zambian prisons interact and affect inmate and officer health. While not a panacea, our findings highlight some strategic entry-points for important upstream and downstream reforms including urgent improvement in the availability of human resources for health; strengthening of facility-based health services systems and more comprehensive pre-service health education for prison officers.

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“…Where the offer of testing is not routine (such as in general outpatients or in-patient wards), uptake can be patchy with success dependant on local programmes, policies and staffing. PITC in these settings has been delivered largely through a task-shifting approach using either dedicated lay counsellors (Taegtmeyer et al, 2011 ), who require additional funding and are trained in a longer counselling protocol intended for the voluntary counselling and testing (VCT) approach; or nurses, many of whom have dual roles (Evans & Ndirangu, 2011 ).…”

Section: Introductionmentioning

confidence: 99%

Opportunities for strengthening provider-initiated testing and counselling for HIV in Namibia

Davyduke

Pietersen²,

Lowrance³

et al. 2015

AIDS Care

Self Cite

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This short report identifies enablers and barriers to the uptake of provider-initiated testing and counselling for HIV (PITC) in Namibia and identifies key opportunities for strengthening this vital aspect of the national HIV response. We explored this through facility mapping, register reviews and qualitative methods including focus group discussions and in-depth interviews. Four health facilities (clinics and hospitals) in two regions were included in the study. We identified that PITC in Namibia was largely delivered by lay counsellors operating in designated rapid testing rooms located in health facilities and found a large number of missed opportunities for HIV testing through this model. Nurses did not see it as an integral part of their role, were not aware of HIV testing and counselling policy, felt inadequately trained and supported, and experienced staffing shortages. Institutional issues also acted as barriers to nurses performing or initiating discussions about PITC. Wider dissemination and implementation of policy, increasing privacy of consultation spaces and community sensitisation are simple measures that represent opportunities for strengthening this response and ensuring that symptomatic individuals who are unaware of their HIV status do not fall through the net.

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A qualitative exploration of the human resource policy implications of voluntary counselling and testing scale-up in Kenya: applying a model for policy analysis

Cited by 16 publications

References 24 publications

Antenatal testing for anaemia, HIV and syphilis in Indonesia – a health systems analysis of low coverage

Antenatal testing for anaemia, HIV and syphilis in Indonesia – a health systems analysis of low coverage

Exploring the drivers of health and healthcare access in Zambian prisons: a health systems approach

Opportunities for strengthening provider-initiated testing and counselling for HIV in Namibia

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