Client and Provider Perspectives of the Efficiency and Quality of Care in the Context of Rapid Scale-Up of Antiretroviral Therapy

Abstract

Global scale-up of antiretroviral therapy (ART) has focused on clinical outcomes with little attention on its impact on existing health systems. In June-August 2008, we conducted a formative evaluation on ART scale-up and clinic operations at three clinics in Uganda to generate lessons for informing policy and larger public health care systems. Site visits and semistructured interviews with 10 ART clients and 6 providers at each clinic were used to examine efficiency of clinic operations (patient flow, staff allocation to appropriate duties, scheduling of clinic visits, record management) and quality of care (attending to both client and provider needs, and providing support for treatment adherence and retention). Clients reported long waiting times but otherwise general satisfaction with the quality of care. Providers reported good patient adherence and retention, and support mechanisms for clients. Like clients, providers mentioned long waiting times and high workload as major challenges to clinic expansion. Providers called for more human resources and stress-release mechanisms to prevent staff burnout. Both providers and clients perceive these clinics to be delivering good quality care, despite the recognition of congested clinics and long waiting times. These findings highlight the need to address clinic efficiency as well as support for providers in the context of rapid scale-up.

Understanding Sustained Retention in HIV/AIDS Care and Treatment: a Synthetic Review

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Strategies for Optimizing Clinic Efficiency in a Community-Based Antiretroviral Treatment Programme in Uganda

“…In this paper we address a critically important aspect of ART scale-up in resource limited settings: poor organization of clinics that wastes patients’ time, deters them from seeking care and reduces adherence including missed clinic visits [15, 16]. The task of providing long-term, quality care for the large volume of patients is overwhelming and effective management of clinic operations is therefore more critical now than ever, not only for clinic efficiency but also for job performance and satisfaction of program staff [5, 6] To achieve efficiency, clinics must consider the model of care including the composition of clinic staff, and the schedule of client visits and how this schedule varies by the client’s stage of care.…”

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Causes of Hospitalization and Perceived Access to Care Among Persons Newly Diagnosed with HIV Infection: Implications for HIV Testing Programs

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