Assessment of the constraints to effective delivery of HIV prevention, treatment and care services in a resource-limited setting
Kenneth Anene Agu, Uche M. Ochei
Department of Clinical Pharmacy and Pharmacy Practice, University of Benin, Nigeria
Corresponding Author: Kenneth Anene Agu
Email: agkenneth@gmail.com; Phone: +2348033031467
ABSTRACT
Background: Scaling up HIV prevention, treatment and care services may face a number of constraints. Project constraint is a barrier to full potential.
Objectives: This study assessed the constraints to effective delivery of HIV prevention, treatment and care services and made recommendations for improvement in resource-limited settings.
Methods: In a cross sectional study, study-specific questionnaires were self-administered to 90 out of 104 health workers providing HIV services and 150 out of 200 HIV-positive patients in seven public health facilities in Edo State, Nigeria. Participants were selected using simple random sampling. Chi square was used for inferential statistics; and P values were two-tailed at 95% confidence interval.
Results: Of the health workers, 59.2% were males, 39.4% aged 31–40 years old, 22.5% doctors, 14.1% pharmacists, 15.5% laboratory scientists, 33.8% nurses, 7.0% record officers, and 7.0% administrators. Of the clients, 55.2% were females, 39.7% aged 31–40 years old; majority (40.5%) had accessed services in the facilities for 1–3 years and 29.3% accessed for 3–6 months prior to this study. Major constraints reported by health workers included inadequate health workforce (24.5%), lack of government ownership (14.9%), lack of incentives/staff motivation(13.8%), and poor working conditions(12.8%); whereas clients reported inadequate health workforce(41.4%), long waiting time (21.4%), stock-out or inadequate supply of drugs, reagents and materials (7.1%). Stigmatization by health workers was reported by 17.6% of clients. Major recommendations by health workers for improvement included recruitment of additional health workforce (36.4%), improved working conditions (15.2%), good staff motivation/incentives (15.2%); whereas clients recommended recruitment of additional health workforce (54.3%), reduced waiting time (13.0%) and improved working conditions (7.6%). However, there was no association between effective delivery of HIV interventions and staff motivation (P=0.0571).
Conclusions: The major constraints reported were inadequate health workforce, lack of government ownership and poor working conditions. Recruitment of additional health workforce and improved working conditions were the major recommendations for improved delivery of quality of HIV interventions.
Keywords: HIV/AIDS, Constraints, Services, Delivery, Health workers, Clients, Nigeria