Nkhata Misheck J, Muzambi Margaret, Ford Deborah, Chan Adrienne K, Abongomera George, Namata Harriet, Mambule Ivan, South Annabelle, Revill Paul, Grundy Caroline, Mabugu Travor, Chiwaula Levison, Hakim James, Kityo Cissy, Reid Andrew, Katabira Elly, Sodhi Sumeet, Gilks Charles F, Gibb Diana M, Seeley Janet, Cataldo Fabian
Dignitas International, Zomba, Malawi.
University of Zimbabwe, Harare, Zimbabwe.
BMC Health Serv Res. 2016 Nov 16;16(1):660. doi: 10.1186/s12913-016-1891-7.
Lablite is an implementation project supporting and studying decentralized antiretroviral therapy (ART) rollout to rural communities in Malawi, Uganda and Zimbabwe. Task shifting is one of the strategies to deal with shortage of health care workers (HCWs) in ART provision. Evaluating Human Resources for Health (HRH) optimization is essential for ensuring access to ART. The Lablite project started with a baseline survey whose aim was to describe and compare national and intercountry delivery of ART services including training, use of laboratories and clinical care.
A cross-sectional survey was conducted between October 2011 and August 2012 in a sample of 81 health facilities representing different regions, facility levels and experience of ART provision in Malawi, Uganda and Zimbabwe. Using a questionnaire, data were collected on facility characteristics, human resources and service provision. Thirty three (33) focus group discussions were conducted with HCWs in a subset of facilities in Malawi and Zimbabwe.
The survey results showed that in Malawi and Uganda, primary care facilities were run by non-physician clinical officers/medical assistants while in Zimbabwe, they were run by nurses/midwives. Across the three countries, turnover of staff was high especially among nurses. Between 10 and 20% of the facilities had at least one clinical officer/medical assistant leave in the 3 months prior to the study. Qualitative results show that HCWs in ART and non-ART facilities perceived a shortage of staff for all services, even prior to the introduction of ART provision. HCWs perceived the introduction of ART as having increased workload. In Malawi, the number of people on ART and hence the workload for HCWs has further increased following the introduction of Option B+ (ART initiation and life-long treatment for HIV positive pregnant and lactating women), resulting in extended working times and concerns that the quality of services have been affected. For some HCWs, perceived low salaries, extended working schedules, lack of training opportunities and inadequate infrastructure for service provision were linked to low job satisfaction and motivation.
ART has been decentralized to lower level facilities in the context of an ongoing HRH crisis and staff shortage, which may compromise the provision of high-quality ART services. Task shifting interventions need adequate resources, relevant training opportunities, and innovative strategies to optimize the operationalization of new WHO treatment guidelines which continue to expand the number of people eligible for ART.
Lablite是一个实施项目，支持并研究在马拉维、乌干达和津巴布韦的农村社区推广分散式抗逆转录病毒疗法（ART）。任务转移是应对抗逆转录病毒治疗中医疗保健工作者（HCW）短缺的策略之一。评估卫生人力资源（HRH）优化对于确保抗逆转录病毒疗法的可及性至关重要。Lablite项目始于一项基线调查，其目的是描述和比较包括培训、实验室使用和临床护理在内的抗逆转录病毒疗法服务的国家和国家间提供情况。
2011年10月至2012年8月期间，在马拉维、乌干达和津巴布韦抽取了81个代表不同地区、机构级别和抗逆转录病毒疗法提供经验的卫生设施进行横断面调查。通过问卷收集了关于机构特征、人力资源和服务提供的数据。在马拉维和津巴布韦的部分设施中，与医疗保健工作者进行了33次焦点小组讨论。
调查结果显示，在马拉维和乌干达，基层医疗设施由非医生临床官员/医疗助理管理，而在津巴布韦，则由护士/助产士管理。在这三个国家，工作人员的流动率都很高，尤其是护士。在研究前的3个月里，10%至20%的设施至少有一名临床官员/医疗助理离职。定性结果表明，即使在引入抗逆转录病毒疗法之前，抗逆转录病毒疗法设施和非抗逆转录病毒疗法设施中的医疗保健工作者都认为所有服务的工作人员短缺。医疗保健工作者认为引入抗逆转录病毒疗法增加了工作量。在马拉维，引入B+方案（为艾滋病毒阳性孕妇和哺乳期妇女启动抗逆转录病毒疗法并进行终身治疗）后，接受抗逆转录病毒疗法的人数增加，因此医疗保健工作者的工作量进一步加大，导致工作时间延长，人们担心服务质量受到影响。对于一些医疗保健工作者来说，低工资、延长的工作时间表、缺乏培训机会以及服务提供的基础设施不足与低工作满意度和积极性有关。
在持续的卫生人力资源危机和人员短缺的背景下，抗逆转录病毒疗法已下放到较低级别的设施，这可能会影响高质量抗逆转录病毒疗法服务的提供。任务转移干预措施需要充足的资源、相关的培训机会和创新策略，以优化新的世卫组织治疗指南的实施，这些指南继续扩大符合抗逆转录病毒疗法条件的人数。
