Abstract
BackgroundHuman resources for health (HRH) constraints are a major barrier to the sustainability of antiretroviral therapy (ART) scale-up programs in Sub-Saharan Africa. Many prior approaches to HRH constraints have taken a top-down trend of generalized global strategies and policy guidelines. The objective of the study was to examine the human resources for health strategies adopted by front-line providers in Uganda to sustain ART delivery beyond the initial ART scale-up phase between 2004 and 2009.MethodsA two-phase mixed-methods approach was adopted. In the first phase, a survey of a nationally representative sample of health facilities (n = 195) across Uganda was conducted. The second phase involved in-depth interviews (n = 36) with ART clinic managers and staff of 6 of the 195 health facilities purposively selected from the first study phase. Quantitative data was analysed based on descriptive statistics, and qualitative data was analysed by coding and thematic analysis.ResultsThe identified strategies were categorized into five themes: (1) providing monetary and non-monetary incentives to health workers on busy ART clinic days; (2) workload reduction through spacing ART clinic appointments; (3) adopting training workshops in ART management as a motivation strategy for health workers; (4) adopting non-physician-centred staffing models; and (5) devising ART program leadership styles that enhanced health worker commitment.ConclusionsFacility-level strategies for responding to HRH constraints are feasible and can contribute to efforts to increase country ownership of HIV programs in resource-limited settings. Consideration of the human resources for health strategies identified in the study by ART program planners and managers could enhance the long-term sustainment of ART programs by providers in resource-limited settings.
Highlights
Human resources for health (HRH) constraints are a major barrier to the sustainability of antiretroviral therapy (ART) scale-up programs in Sub-Saharan Africa
Our findings demonstrate that providers devised a mix of monetary and non-monetary incentives to enhance the morale of health workers on ART clinic days which were characterized by high out-patient workloads
The results show that health workers responded positively to monetary incentives such as salary top-ups and lunch allowances on ART clinic days
Summary
Human resources for health (HRH) constraints are a major barrier to the sustainability of antiretroviral therapy (ART) scale-up programs in Sub-Saharan Africa. The Sustainable Development Goals (SDGs) announced in September 2015 retained universal access to ART in the new Achieving these new global targets will necessitate overcoming a myriad of health system constraints in SubSaharan Africa which is the region with highest HIV burden in the world [5, 6]. These include sustaining funding to levels that are commensurate with the needs of the HIV response, securing ART commodity supply chains and resolving bottlenecks in service delivery [1, 7]. From a total of 400,000 who were enrolled on ART in 2003 [9], the population enrolled on ART had risen to 15 million by mid-2015 [2]
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