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.
Highlights
The current crisis in human resources (HR) for health in many low- and middle-income countries raises uncertainty about how international goals for scale-up of HIV-related services can be met [1,2,3,4]
We describe below the level, characteristics and changes in HR integration in the context of other elements of HIV/sexual and reproductive health (SRH) service integration in two African settings, and explore the impact of HR integration on staff workload and productivity
Non-core services are HIV/sexually transmitted infections (HIV/STI) services not consistently offered within maternal and child health (MCH) departments, including STI management (STI), HIV Counselling and testing (including voluntary HIV counselling and testing (VCT) and provider-initiated HIV testing and counselling (PITC)), cervical cancer screening (CaCx), CD4 count testing services, and antiretroviral therapy (ART)
Summary
The current crisis in human resources (HR) for health in many low- and middle-income countries raises uncertainty about how international goals for scale-up of HIV-related services can be met [1,2,3,4]. There is an absolute shortage of qualified staff, leading to great need for efficiency improvements in HR utilization This absolute shortage is often further exacerbated by inequitable distribution of health workers, causing some existing staff to become overworked while in other areas there may be excess capacity at the provider level. There 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 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 absorb HIV services
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