ART Delivery in Health Centres in

Uganda: a Qualitative Assessment of

the Impact on Health Centre Staff

Flavia Zalwango, Celestine Ilakut, Remmie Kimera,

Benson Droti and Janet Seeley

MRC/UVRI Uganda Research Unit on AIDS

5th SAHARA conference, South Africa, 30th November – 3rd December 2009

1

Overview of presentation

• Background to the study

• Methods

• Findings:

– Before and after ART

– Benefits of rolling out ART to lower health centres

– Challenges of ART delivery

• Discussion and conclusion

2

Background

ART provision will be rolled-out to peripheral health centres in Uganda by Government to:

- Increase equity of access

- reduce burden on higher level centres

- reduce cost to clients of accessing health care

- enhance clients’ adherence to ARVs

•The Wakiso project in Uganda is piloting ART delivery to health centres to evaluate the approach.

3

Aim of the study

To assess the perceived impact on

workloads and working practices of

health centre staff of the roll out of

ART to peripheral government

health centres in Uganda.

4

Sample

• 14 staff (10 women and 4 men) involved in ART delivery:

• Selected from 3 health centres (1 rural/2 peri-urban)

• Staff representing different positions in the health service (medical assistants/nurses).

5

Method

• Semi-structured interviews:

– collecting data on:

•career history

•day-to-day tasks before and after

the roll-out of ART to their health

centre.6

Analysis

• Thematic content analysis was

used for analysis.

–Data were coded manually by

two research team members,

who discussed and compared

their coding.7

Findings

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Situation before ART

Work was:

• relatively easier due to clear

allocation of tasks;

• repetitive;

• enjoyable and manageable.

9

Situation after ART

• Special clinic days for HIV clients

(including PMTCT, community outreach);

• New services such as VCT and Behaviour

Change Communication were introduced;

• Changes in work patterns;

• Time pressure.

10

“….when the ART programme was brought into this centre the work that I was doing here really increased and it is time consuming. These people that we come across are not easy because they expect a lot from us and need much more attention …”

(female health worker, aged 35)

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Benefits of rolling out ART

To the health worker:• Health worker - client contact increased;

• Relationships with clients and fellow staff improved;

• Training opportunities available for health workers;

• Promoted teamwork among health workers.

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“The relationship with patients has increased because after the trainings, we the health service providers are treating the patients with more attention and care unlike before and we really keep following them up just to know how they are doing.”

(Male health worker, aged 29)

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Benefits of rolling out ART

To the clients (as perceived by the

staff):

• Increased access to HIV treatment and

care near their homes;

• Increased contact time with health

workers.

14

A health worker offering treatment and

support to a client at one of the Health Centres

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Challenges of ART delivery

Staff related:

• Lack of mentoring and support;

• Longer working hours;

• Low pay despite increased

responsibilities.

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Challenges of ART delivery

Institutional:• Lack essential drugs;

• Shortage of staff experienced in ART delivery;

• Growing numbers of patients.

Client related:• Some did not adhere to treatment schedules.

• Poor family planning.

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“Many of these mothers come with very sick children. When they are clinically observed, most of them are malnourished and yet some of the mothers continue getting pregnant despite the counselling they receive at the centre.”(Female health worker, aged 22)

Discussion

• ART delivery is demanding in terms of personnel, finances and time.

But• while challenges remain, the health centre

staff believe that, if supported, they can deliver ART effectively.

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Conclusion

Rolling out ART has:

– Brought services closer to the people;

– Increased contact time between

health workers and clients;

– Increased clients’ access to HIV

treatment and care.

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Acknowledgements

• Our thanks to the Evidence for Action

Research Programme Consortium (DFID) and

MRC for funding for this study.

• We are grateful to the staff for giving us their

time.

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