The impact of HIV/SRH service integration on workload: analysis from the Integra Initiative in two African settings

Abstract

BackgroundThere is growing interest in integration of HIV and sexual and reproductive health (SRH) services as a way to improve the efficiency of human resources (HR) for health in low- and middle-income countries. Although this is supported by a wealth of evidence on the acceptability and clinical effectiveness of service integration, there is little evidence on whether staff in general health services can easily absorb HIV services.MethodsWe conducted a descriptive analysis of HR integration through task shifting/sharing and staff workload in the context of the Integra Initiative - a large-scale five-year evaluation of HIV/SRH integration. We describe the level, characteristics and changes in HR integration in the context of wider efforts to integrate HIV/SRH, and explore the impact of HR integration on staff workload.ResultsImprovements in the range of services provided by staff (HR integration) were more likely to be achieved in facilities which also improved other elements of integration. While there was no overall relationship between integration and workload at the facility level, HIV/SRH integration may be most influential on staff workload for provider-initiated HIV testing and counselling (PITC) and postnatal care (PNC) services, particularly where HIV care and treatment services are being supported with extra SRH/HIV staffing. Our findings therefore suggest that there may be potential for further efficiency gains through integration, but overall the pace of improvement is slow.ConclusionsThis descriptive analysis explores the effect of HIV/SRH integration on staff workload through economies of scale and scope in high- and medium-HIV prevalence settings. We find some evidence to suggest that there is potential to improve productivity through integration, but, at the same time, significant challenges are being faced, with the pace of productivity gain slow. We recommend that efforts to implement integration are assessed in the broader context of HR planning to ensure that neither staff nor patients are negatively impacted by integration policy.

Innovation in Evaluating the Impact of Integrated Service-Delivery: The Integra Indexes of HIV and Reproductive Health Integration

“…do you need physical and human resource integration in place before you get availability of services within an MCH unit and what enables this to lead to delivery of integrated care?) [ 37 , 38 ]. Third, the Indexes can enable researchers to improve the assessment of the attribution of a particular health or service outcome to service integration.…”

Service integration: opportunities to expand access to antiretroviral therapy for people who inject drugs in Tanzania

“…Integrating services into one location for clients is a necessary but insufficient structural solution, as simply adding more responsibilities to an already overburdened workforce will not yield the results needed. The linchpin for effective integration of HIV care will be to ensure an adequate number of health workers with the right skillset [ 20 ]. By building a strong workforce at the methadone clinics, providers will be able to effectively attend to the needs of their clients, efficiently offering all of the necessary clinical, laboratory and pharmacy services in one location.…”

The Current Status of Research on the Integration of Sexual and Reproductive Health and HIV Services

“…Evidence suggests the potential of improved productivity through integration, but at the same time there are significant challenges with the pace of productivity gain (Sweeney et al. ). Progress toward providing universal health care requires changing how health systems interact with communities and clients, and incorporating integration as a core principle in service delivery.…”

“…This special issue demonstrates that much has been achieved since the Glion Call to action in 2004, but challenges continue with integrating HIV and SRH services-two obviously interrelated programs. Evidence suggests the potential of improved productivity through integration, but at the same time there are significant challenges with the pace of productivity gain (Sweeney et al 2014). Progress toward providing universal health care requires changing how health systems interact with communities and clients, and incorporating integration as a core principle in service delivery.…”

“…This includes infrastructure, equipment, and commodities, and a skilled, efficient health workforce (in sufficient numbers) at all levels, but primarily at the community and first level of care. Moreover, efforts to implement integration need to be assessed within the broader context of human resource planning to ensure that neither staff nor clients are negatively affected by integration policy, and that providers' concerns about staffing, training, and commodity stock-outs are addressed (Mutemwa et al 2013;Wilcher et al 2013a;Ndwiga et al 2014;Sweeney et al 2014;Newmann et al 2015). These healthsystems obstacles need to be resolved to enable scale-up and sustainability of cost-effective, integrated service provision (Wilcher et al 2013a;Newmann et al 2015;Mayhew et al 2016).…”