Kamanga Gift, Hoffman Irving, Malata Address, Wheeler Stephanie, Chilongozi David, Babich Suzanne
FHI 360, Lilongwe, Malawi.
Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, United States.
Malawi Med J. 2018 Jun;30(2):54-60. doi: 10.4314/mmj.v30i2.1.
Malawi published its first ever HIV and AIDS policy in 2003. The implementation of the policy provided a very necessary and historic step in Malawi's organized response towards HIV and AIDS. Many achievements were registered in the period this policy was implemented. However, some components of the policy were not well-implemented. Our study explored barriers to implementation of provider initiated HIV testing and counseling (PITC) for sexually transmitted infections (STI) within general outpatient settings. Malawi also launched a revised HIV and AIDS Policy in December 2013. Although not part of this policy analysis, future years of implementation may face related issues observed during the implementation of the 2003-2013 policy.
This is a non-experimental, descriptive study using a case study design. We examined the implementation of provider initiated HIV testing and counseling component of the Malawi HIV and AIDS policy from 2003-2013 focusing on STI and outpatient clinic settings. We sought to understand perspectives of various stakeholders and users of the policy. We conducted in-depth interviews with policy makers, health care worker supervisors, health care workers and health rights activists.
Major problems which affected the implementation of the 2003-2013 HIV policy were: selective prioritization of policies by government, lack of involvement of implementers in the policy making process, non-awareness of health workers about the existence of the policy, lack of healthcare worker training, unsatisfactory supervision of policy implementation, poor harmonization of policies, lack of clarity about guidance to those directly implementing, unclear roles and reporting authority among the main national coordinating units.
Good leadership, effective coordination, involvement of key players in the policy making process, dissemination to primary users and decentralization or empowerment of local supervisors is key to successful policy implementation.
马拉维于2003年发布了其有史以来的首个艾滋病毒和艾滋病政策。该政策的实施是马拉维对艾滋病毒和艾滋病进行有组织应对过程中非常必要且具有历史意义的一步。在该政策实施期间取得了许多成就。然而，该政策的一些组成部分实施得并不理想。我们的研究探讨了在普通门诊环境中实施由医护人员发起的性传播感染（STI）艾滋病毒检测和咨询（PITC）的障碍。马拉维还于2013年12月推出了修订后的艾滋病毒和艾滋病政策。尽管本政策分析未涉及此内容，但未来几年的实施可能会面临在2003 - 2013年政策实施期间观察到的相关问题。
这是一项采用案例研究设计的非实验性描述性研究。我们研究了2003 - 2013年马拉维艾滋病毒和艾滋病政策中由医护人员发起的艾滋病毒检测和咨询部分的实施情况，重点关注性传播感染和门诊诊所环境。我们试图了解该政策的各种利益相关者和使用者的观点。我们对政策制定者、医护人员主管、医护人员和健康权利活动家进行了深入访谈。
影响2003 - 2013年艾滋病毒政策实施的主要问题包括：政府对政策的选择性优先排序、实施者未参与政策制定过程、医护人员对政策存在缺乏认识、缺乏医护人员培训、对政策实施的监督不力、政策协调不佳、对直接实施者的指导不明确、主要国家协调单位之间的角色和报告权限不清晰。
良好的领导、有效的协调、关键参与者参与政策制定过程、向主要使用者进行宣传以及地方主管的权力下放或赋权是政策成功实施的关键。
