Formative study on hiv workplace for health workers - copy

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Heterogeneity of the HIV epidemic in Lesotho
Formative Assessment: MOHSW
SECTORAL RESPONSE -MOHSW
ACTIONS TAKEN AND TOOLS AVAILABLE - TO DATE
DISSEMINATION- tools
ADVOCACY FOR BUY IN- - PPP
WELLNESS CHAMPIONS AND STRUCTURES
ADVOCACY-WELLNESS ACTIVITIES
M/E Tools
Cost benefit analysis
Learning and sharing

Action Research : Sejojo Phaaroe
3D MEDIA

Published in: Health & Medicine
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Formative study on hiv workplace for health workers - copy

  1. 1. HIV and AIDS in the Workplace for Health Workforce – Formative Assessment: Lesotho Sejojo Phaaroe
  2. 2. Know where you are and where you are going
  3. 3. Lesotho Mountain terrains
  4. 4. About Lesotho
  5. 5. OUT LINE  Heterogeneity of the HIV epidemic in Lesotho  Formative Assessment: MOHSW  SECTORAL RESPONSE -MOHSW  ACTIONS TAKEN AND TOOLS AVAILABLE - TO DATE  DISSEMINATION- tools  ADVOCACY FOR BUY IN- - PPP  WELLNESS CHAMPIONS AND STRUCTURES  ADVOCACY-WELLNESS ACTIVITIES  M/E Tools  Cost benefit analysis  Learning and sharing
  6. 6. Goal HIV and AIDS in the Workplace Policy for Health Workforce our programme must be designed to enable behaviour change by providing employees with tools that encourage and support HIV negative employees to stay negative, and those living with HIV and AIDS to lead a functional and productive life
  7. 7. There is no need to catch a ball if you do not know where the goal is
  8. 8. Goal  Sustainable - process cycle / driven - build capacity - monitoring and evaluation - record keeping -cost benefit analysis - efficacy - Make alterations
  9. 9. HOW BIG IS THE PROBLEM? HIV AND AIDS AMONGST HEALTH CARE GIVERS AND THEIR FAMILIES
  10. 10. Response?
  11. 11. Response? I see how big it is but there is nothing I can do!
  12. 12. Response!!!! HIV and AIDS is a workplace issue Lets take immediate strategic measurable action!!!
  13. 13. A Major Pillar for any HIV program
  14. 14. Total: 33.2 (30.6 – 36.1) million Western & Central Europe 760 000 [600 000 – 1.1 million] Middle East & North Africa 380 000 [270 000 – 500 000] Sub-Saharan Africa 22.5 million [20.9 – 24.3 million] Eastern Europe & Central Asia 1.6 million [1.2 – 2.1 million] South & South-East Asia 4.0 million [3.3 – 5.1 million] Oceania 75 000 [53 000 – 120 000] North America 1.3 million [480 000 – 1.9 million] Latin America 1.6 million [1.4 – 1.9 million] East Asia 800 000 [620 000 – 960 000] Caribbean 230 000 [210 000 – 270 000] Adults and children estimated to be living with HIV 2007
  15. 15. Estimated number of adults and children newly infected with HIV, 2007 Western & Central Europe 31 000 [19 000 – 86 000] Middle East & North Africa 35 000 [16 000 – 65 000] Sub-Saharan Africa 1.7 million [1.4 – 2.4 million] Eastern Europe & Central Asia 150 000 [70 000 – 290 000] South & South-East Asia 340 000 [180 000 – 740 000] Oceania 14 000 [11 000 – 26 000] North America 46 000 [38 000 – 68 000] Latin America 100 000 [47 000 – 220 000] East Asia 92 000 [21 000 – 220 000] Caribbean 17 000 [15 000 – 23 000] Total: 2.5 (1.8 – 4.1) million
  16. 16. Western & Central Europe <1000 [630 – 3100] Middle East & North Africa 5500 [3800 – 8200] Sub-Saharan Africa 370 000 [320 000 – 470 000] Eastern Europe & Central Asia 3500 [2200 – 6400] South & South-East Asia 24 000 [14 000 – 31 000] Oceania <1000 [<1000 – 1400] North America 1600 [<1000] Latin America 6700 [5500 – 12 000] East Asia 2100 [<1000 – 2100] Caribbean 2000 [1800 – 3400] Estimated number of children (<15 years) newly infected with HIV, 2007 Total: 420 000 (350 000 – 540 000)
  17. 17. Estimated adult and child deaths from AIDS, 2007 Western & Central Europe 12 000 [<15 000] Middle East & North Africa 25 000 [20 000 – 34 000] Sub-Saharan Africa 1.6 million [1.5 – 2.0 million] Eastern Europe & Central Asia 55 000 [42 000 – 88 000] South & South-East Asia 270 000 [230 000 – 380 000] Oceania 1200 [<500 – 2700] North America 21 000 [18 000 – 31 000] Latin America 58 000 [49 000 – 91 000] East Asia 32 000 [28 000 – 49 000] Caribbean 11 000 [9800 – 18 000] Total: 2.1 (1.9 – 2.4) million
  18. 18. Amongst them are health workers
  19. 19. Amongst them are health workers
  20. 20. Amongst them are health workers
  21. 21. Amongst them are health workers
  22. 22. Amongst them are health workers
  23. 23. Amongst them are health workers
  24. 24. Amongst them are health workers
  25. 25. Amongst them are health workers
  26. 26. Heterogeneity of the HIV epidemic in Lesotho Lower HIV prevalence Higher HIV prevalence Males aged 15-30 years (10.1%) Females aged 15-30 years (21.4%) Females aged 40-50 years (23.3%) Males aged 40-50 years (30.9%) Men and women living in rural areas (21.9%) Men and women living in urban areas (29.1%) Poorer women (19.6% in lowest quintile) Wealthier women (28.9% in highest quintile) Men and women who are not working (19.9%)* Working men and women (30.3%)* Men and women with education (23.2%) Men and women without education (27.4%) Never-married men who have had sex (11.4%) Never-married women who have had sex (24.2%) Married women (26.9%) Married men (32.9%) Men and women without sex partner in last 12 months (23.1%) Men and women with 1 or more sex partners in last 12 months (28.3%) Women reporting sex only with spouse or cohabiting partner in last 12 months (27.4%) Women who had higher-risk sex in last 12 months (37.2%)
  27. 27. Statistics  120 000 AIDS orphans in Lesotho  HEALTH CARE WORKERS‟ OPHANS ARE THEY INCLUDED IN THE OVC PROGRAMMS?
  28. 28. THE TRANSMISSION OF HIV How do you become infected with HIV?
  29. 29. UNDERSTANDING HIV / AIDS H : I : V : HUMAN IMMUNE DEFICIENCY VIRUS HIV is therefore a virus that breaks down the immune system within human beings A : I : D : S : ACQUIRED IMMUNE DEFICIENCY SYNDROME AIDS is therefore a collection of many infections in the body as a result of a weakened immune system caused by the HIV Virus
  30. 30.  Virus does not survive outside the body  Cannot enter through intact skin  Quantity of virus  Enough time  Point of entry  Enough Quantity THREE CONDITIONS FOR TRANSMISSION: NO TRANSMISSION BECAUSE:
  31. 31. You will NOT transmit HIV through: SOCIAL CONTACT Shaking hands, swimming, kissing, hugging, sharing toilet, cutlery BEING WITH AN HIV+ PERSON TRAVELLING FOOD AND EATING WORK ENVIRONMENT
  32. 32. HIV can only be transmitted through: Unprotected sexual intercourse Infected blood Intra-venous drugging Mother-to-child X   
  33. 33. Unprotected sexual intercourse
  34. 34. Structure of a killer disease-HIV
  35. 35. HIV Lifecycle 1. Attachment - Fusion Reverse Transcriptions Act Here 2. Entry 3. Transcription 4. Integration 5. Polyprotein Production 6. Release – Assembly & Budding 7. Maturation 7 Protease inhibitors Act Here  Phases: binding and entry, reverse transcription, replication, budding, and maturation
  36. 36. Cytology micrograph of HIV BUDDING
  37. 37. HIV Clinical stages at different CD + counts (1993 CDC)CD 4+ COUNT INFECTIONS NEOPLASIA/ CANCERS >500 cells/ ml CANDIDIASIS CERVICITIES CIN Invasive Cancer of cervix Idiopathic Thrombocytopenia purpura Hodkins Lymphoma Non Hogkins Lymphoma K.S 200-500 TB , Bacterial pneumonia Herpes Zoster Oral candidiasis Oesophagial candidiasis CIN Invasive Cancer of cervix Idiopathic Thrombocytopenia purpura Hodkins Lymphoma Non Hogkins Lymphoma K.S 50- 200 Extra pulmonary TB PCP Cryptococoosis Toxoplasmosis Blastomycetes Septicaemia Herpes Wasting- Anaemia Peripheral Neuropathy Non Hodgkins Lymphoma Cardiomyopathy <50 CMV
  38. 38. Natural History of HIV Infection
  39. 39.  Viral  Herpes simplex virus  Varicella Zoster virus  Cytomegalovirus  Molluscum contagiosum  EBV  JCV  HPV  Bacterial  Pneumococcus  H. Influenza  Staphylococcus  TB  nocardia  Salmonella  Klebsiella  Pseudomonus  Rhodococcus equi
  40. 40. Where are OIs come from in the health work place ?  Food Raw vegetables, fruits Raw meat, eggs, poultry Stored food, unwashed food  Water Cryptsporidiosis, microsporidiosis  Air TB, Cryptocococcus
  41. 41. Summary of General Side Effects of Drugs- especially ART The lab plays a major role in the diagnosis and monitoring  NeuromuscularNeuromuscular –– MyopathyMyopathy –– PeripheralPeripheral neuropathyneuropathy  AbdominalAbdominal –– PancreatitisPancreatitis –– HepaticHepatic  BoneBone –– OsteonecrosisOsteonecrosis –– OsteoporosisOsteoporosis  MetabolicMetabolic –– LacticLactic AcidemiaAcidemia –– LipodystrophyLipodystrophy –– DyslipidemiaDyslipidemia –– DiabetesDiabetes  HypersensitivityHypersensitivity  HematologicHematologic –– AnemiaAnemia
  42. 42. Palliative care is a continuum of care from diagnosis to death Island Hospice Service Palliative care death Disease modifying therapy (curative, life prolonging or palliative in intent) illness Presentation- diagnosis bereavement careCurative Adapted from: American Medical Association. Institute for Medical Ethics (1999) EPEC: education for physicians on end-of-life care.
  43. 43. Palliative care in the developing world Death Disease-oriented care Supportive & Palliative Care Impacts on Individual, Family, Community Care of orphans Bereavement Care Diagnosis Hospice Care Primary Health Care & Specialist Care Adapted from WHO: Defilippi, Gwyther 2002
  44. 44. WHAT IS THE IMPACT OF HIV IN THE WORK PLACE FOR THE HEALTH WORKFORCE IN LESOTHO? BIG QUESTION!!!!!!!
  45. 45. Formative Assessment: Attitudes and needs of employees of the MOHSW for development of HIV and AIDS Policy and Intervention Programmes What has been done so far for health workforce
  46. 46. Presentation Outline 1. Study methodology included Key research Questions, selection criteria 2. Limitations of the study 3. Study Findings  Study Participants  Perceptions of Health Care Workers regarding existing HIV vulnerabilities in the workplace.  Current status on programming, services and activities for employees 4. Implications for MOHSW & Partners 5. Conclusions & Recommendations
  47. 47. 1. Study Methodology Formative assessment using both qualitative & quantitative measures in order to triangulate results & findings: • Desk reviews, stakeholder consultations • Data analysis – , Thematic analysis (manual) • Documentation
  48. 48. Key Research Questions i) What are the existing perceptions, attitudes and vulnerabilities of HCWs in relation to HIV and AIDS in the workplace? ii) What is the current status of HIV and AIDS programming, services and activities for employees of the MOHSW and CHAL iii) What programmes, services and activities need to be put in place? What priorities should the policy address regarding protection and rights of HCWs including HIV and AIDS stigma and discrimination in the workplace?
  49. 49. Limitations to the study  More junior staff participated in the study due to availability, small numbers of staff, workshops, work shifts etc.  Some staff felt not particularly part of the study – Lab staff at HQs levels  There are very small numbers of doctors due to their small number (and unavailability due to workload)
  50. 50. Participating Facilities  Quthing (Quthing Hospital & Villa Maria Health Centre)  Maseru (Scott Hospital & St. Barnabas Health Centre)  Berea (Maloti Adventist Hospital & Mapheleng Health Centre)  Leribe ( Motebang Hospital & Maputsoe Filter Clinic)
  51. 51. Study Participants Name of district Quthi ngLeri beBereaMaseru Count 60 50 40 30 20 10 0 Office Assi stant Nurse Assi stant Messenger HIV/AIDS Focal Poi nt Cleaner Pharmacy Techni ci an Admi ni strator Registered Nurs Pri nci pal Pharm acy T echni ci an Dri ver Matron
  52. 52. Study Participants  Administrators 32.6%  Nursing staff 21.3%  Doctors 0.6%  Pharmacy staff 8%  CHWs 7.3%  Other personnel/support staff 44.7%
  53. 53. Study Participants Current Post Districts Total Msu Ber Lrb Qtg Administrator 25 9 7 8 49 Doctor - 1 - - 1 Nursing staff 4 14 8 6 32
  54. 54. Study Participants Current Post Districts Total Ms u Ber Lr b Qtg Pharmacy 10 - 2 - 12 HIV Focal Points 1 1 1 - 3 CHWs 2 2 3 4 11 Information Officers - - 1 - 1
  55. 55. Study Participants Current Position Districts Total Msu Ber Lrb Qt g Lab Services 1 - - - 1 Environmental Officer - - 2 1 3 Social Workers 1 1 1 - 3 Chief Health Educator 1 - - - 1
  56. 56. Study Participants Current Post Districts Total Msu Ber Lrb Qtg Social Workers 1 1 1 - 3 Human Resources 2 - 1 - 3 DGHS 1 - - - 1 PHC Director 1 - - - 1 CNO 1 - - - 1
  57. 57. Study Participants Current Post Districts Total Msu Ber Lrb Qut Orthopaedic Technician 1 - 1 - 2 Statistician 1 - - - 1 Radiography Asst - 1 - - 1
  58. 58. 1. HIV Risk Factors What are the job related tasks that expose employees to risk of infection at the workplace? HSA H/Q Quthi ng Motebang Mal uti Scott Count 40 30 20 10 0 Contact wi th patient s Taki ng blood samples to l ab All of the above Handling contami nate d needles Sti chi ng/wound dress ing Admi ni stering inject ions Mi ssing
  59. 59. 1.1 Workplace Related vulnerability 1. Needle stick related injuries (88.4%) 2. No: of immediate risk in work environment (5.4%) 3. Other (includes contact with patients, working with bare hands, taking blood samples to lab etc) (6.2%)
  60. 60. 1.2 Reasons for Vulnerability HCWs believe they are at risk of contracting HIV infection at workplace due to Needle stick injuries, Blood splashes, cleaning & disposal tasks etc. This they see as inevitable given the nature of their work. (Occupational hazard)
  61. 61. 1.3 Other Reasons for Vulnerability 1. Inadequate supply & less reliable protective clothing 2. Shortage of staff which requires other non-nursing professionals to assist & give care (cleaners, pharmacists, laboratory etc) 3. Inadequate knowledge & skills on how to properly handle potentially harmful materials due to lack of materials, training, induction and supervision 4. Limited availability & access to PEP (knowledge, stocks & info on correct use)
  62. 62. 1.3 Other Reasons for Vulnerability (Cont…) 5. Sharps and medical waste disposal is not supervised. - Containers not available/misused - No disposal facilities at health centre level. 6. Supervision – Rarely done. Staff expected “to know”. Cleaners only responsible to Administrator (GoL). 7. Hand-washing – Not mentioned anywhere as one of the precautionary measures.
  63. 63. 1.4 Workers’ Response to risk As a consequence, HCWs feel; • Worried (they will get/are infected) • Neglected - not important to employer; no support systems in place; remuneration low • Stressed – how families will cope
  64. 64. 1.5 Sectoral Response Despite the mentioned risks no specific Prevention and occupational health and Safety programmes are in place to reduce risk of infection
  65. 65. 1.6 Implications to MOHSW and Partners  High levels of infection among HCWs resulting in ill health & death  Resignations as people seek better opportunities elsewhere  Retraining costs to replace lost staff  Reduced levels in quality of care as sector loses trained & experienced workers
  66. 66. 4. Conclusions of the survey There is;  High HIV infection vulnerability at work place  Negative and unsupportive attitudes from workers (Stigma/discrimination)  Lack of care & support services  Inadequate info/knowledge on HIV and AIDS latest trends and developments in terms of service & equipment
  67. 67. Recommendations (short term) 1. Workplace HIV and AIDS prevention programme should be initiated to address the high levels of risk identified. It should include –  Strict adherence to safety precautions  Availability & access to PEP and its use  Prevention interventions for all workers (all ages)  Counselling (psychosocial) support to manage stress 2. Support systems – Policy to facilitate access to confidential HIV and AIDS services  testing  Counselling  staff clinics
  68. 68. Recommendations (Long term) 1. Development of HIV & AIDS workplace policy, strategy- which we are disseminating today 2. Integrate HIV & AIDS information in all training programmes- including L&S FORUMS 3. Improve HR systems – Task shifting-SAHCD,MHS 4. Improve incentive/remuneration packages to take into account new responsibilities 5. Strengthen partnerships –, international organizations etc- we have presented to them for buy-in purposes 6. Develop wellness centers for health workforce
  69. 69. PRINCIPAL SECRETARY National Wellness Committee Director Human Resource TECHNICAL WORKING COMMITTEE South (Kkotso, Itumeleng, Mabokang), Nthateng Central (Nthabiseng, Sejojo, Mpho, Mosala ) North (Mokebisa, Nkemele, Petlane) FACILITIES WELLNESS COMMITTEES WORK PLACE WELLNESS STRUCTURE
  70. 70. ACTION PLAN FOR LESOTHO WORK PLACE WELLNESS PROGRAMME SERVICES TO BE PROVIDED AT FACILITY LEVEL Services Activities Responsibility Required resources Available resources Partners/dept M&E Initiate the wellness programme -Sensitize Management and staff about the programme -Nominate the Wellness committee -Identify and lobby for space and equipment for the Wellness Clinic -Adopt the action plan for the programme Wellness Champions Work Place Policy Strategic plan Draft Work plan A room Equipment HR Work Place Policy Strategic plan Draft work plan A room Equipment HR Heads of Departments Partners Existence of a Wellness programme Provide Preventive services Provide the following services: -Health Education -HIV Testing and Counseling -PMTCT -PEP -Vaccines -Screening; Blood pressure, Blood sugar levels, TB, STI, Diabetes, Oral health, weight and height Wellness Committee -Testing kits -IEC materials -Drugs -PEP Kits -Vaccines -BP Machine Glucometer Stationary -Stethoscope -Scale Lancets Cotton swabs -Testing kits -Drugs -Heads of Dept -Clinical staff -partners No of services provided % of people accessing services Curative services -Undertake consultation and provide prescription -Provide health education -Initiate ARV drugs -monitor treatment- Lab tests -Wellness Committee -Clinical staff -Medical equipment ARV drugs Lab Monitoring (CD4,LFTS,FBC,U A, Pap test, lactate, -Clinical staff -Clinical staff Heads of Dept No of consultatio ns Today's –buy in
  71. 71. Stress management Initiate and coordinate recreational activities - Aerobics - Ball games - Gymnasium Wellness committee -Hall -Ball -skipping ropes -Grounds Stress balls, balloons, equipment Hall -Ball -skipping ropes -Grounds Stress balls, balloons, equipment -Heads of Dept No of staff members accessing the services Care & support -Provide psychological Counseling -Establishing support groups -Palliative care services -Christian health fellowships -home based care visits Wellness committee - Wellness centre - HR - Wellnes s centre - HR Partners & HODs - Nurse Counselors -Support groups -Peer educators -No of active support groups -No of HW counseled Referral services -Establish referral procedures among well clinics in different hospitals. - Wellness Committee Referral forms HR Referral forms HR HODs Medical Officer Number of referral cases made
  72. 72. How will these help?- Measure and respond The impact  On the individual  On the family  On the workplace  On the community  On the government / country
  73. 73. Economic impact of HIV/AIDS ECONOMY WORKPLACE INDIVIDUAL ILLNESSES & DEATHS IMPACT WILL DEPEND ON NUMBER OF PEOPLE THEIR EMPLOYMENT STATUS INFECTED UNEMPLOYED / SKILLED / HIGHLY UNSKILLED PRODUCTIVE 27% (HIV+) 12% (HIV+)
  74. 74. Current Economy?  Global financial – economic crisis  Ripples into social crisis  Southern Africa HIV pandemic added fuel  Reduction / abolishment of employee support programmes
  75. 75. Effect  Increased pressure on employee  Increased pressure on Champion  Increased pressure on PEERS  Retrenched people
  76. 76. Effect  Increased risk of HIV / Diseases - Alcohol abuse - Drug abuse - High risk sexual behavior - Financial problems - Stress - Depression -BURNOUT
  77. 77. REVIEWS EXISTING AND NEW NATIONAL POLICIES, LEGAL FRAMEWORKS AND EMPLOYMENT AND LABOUR LAWS WFP OVC
  78. 78. The impact of HIV/AIDS An individual HEALTH CAREGIVER FAMILY MEMBER: Income earner Caregiver Educator Lack of family structures and finances Lack of support COMMUNITY MEMBER: Leadership Service Support CONSUMER Economic Slow down – Individual + Community Suffering PRODUCER: Productivity losses Increased costs – staff replacement High medical cost - Illness Labour loss - Death Reduced market for products
  79. 79. The impact on labour force BIGGEST IMPACT ON: Availability: Skills shortage Recruiting from limited pool Performance: Cost of labour: Increase in Remuneration, Recruitment, Training and Retraining IMPACT MAY CAUSE CHANGES RE:  Age/experience of workforce  Wage costs of top skilled employees  Size of work force  Keep retired employees longer
  80. 80. The most important effects on organisations Decreased productivity Increased absenteeism Increased ill health retirement Early disability Loss of skill – increased recruitment & training cost Risk - financial - morale - quality
  81. 81. Impact on absenteeism Absenteeism due to:  Illness of HIV (+) employees  HIV (-) employees to care & support family  Attending funerals  Mental absenteeism
  82. 82. Impact on employee benefits Impact will Primarily depend on:  Business type  Conditions of employment  Skills level of staff  Benefits provided by a company  Ability to replace employees Secondary impact:  The management of HIV(-) employees  Provision of ART/ General treatment  Point of incapacity / ill health retirement Benefits may rise from 12% to 18% HIV 30% of all medical costs Loss of cross subsidy
  83. 83. Cost of HIV and AIDS DIRECT / INDICRECT / SYSTEMIC COST PROGRESSION OF HIV AND THE COST TO THE ORGANISATION
  84. 84. Why HIV and AIDS Workplace programme?  National prevalence  Value of human capital  Risks - financial - morale - quality  Moral obligation: It is the right thing to do
  85. 85. Make HIV and AIDS a boardroom issue and not a bedroom issue
  86. 86. What are the ethical & legal implications?
  87. 87. Stigma HIV/AIDS-Related Stigma: “a „process of devaluation‟ of people either living with or associated with HIV/AIDS”. (UNAIDS) HIV/AIDS-related Discrimination: “Discrimination follows stigma and is the unfair and unjust treatment of an individual based on his or her real or perceived HIV status”. (UNAIDS)
  88. 88. Race Pregnancy Disability Gender Culture Sexual Orientation HIV status Language Belief / Religion Colour Marital Status Ethnic / social origin  Does the action affect any of the under mentioned?  Does it impose a burden (s), obligation (s) or disadvantage?  Does it withhold benefit (s) , opportunities or advantages? Are you one of the puzzle? Were you discriminated against? The following questions will determine whether it was fair of unfair discrimination
  89. 89. Key HIV related legal issues  Eliminating unfair discrimination and promoting a non-discriminatory workplace  No direct or indirect discrimination  Confidentiality and disclosure  Informed consent  Promoting a safe working environment
  90. 90. Legislation within the workplaceLAW RIGHT Constitution Labour Relations Act (LRA) EQUALITY / FREEDOM / PRIVACY / ACCESS TO HEALTH CARE a) Right to fair Labour practices b) Right not to be unfairly dismissed because of HIV + status
  91. 91. Legislation within the workplace LAW RIGHT Employment Equity Act (EEA) a) Right not to be unfairly discriminated against on the basis of your HIV status b) Right not to be tested for HIV unless your employer ahs applied to the Labour Court for authorisation c) Do not have to disclose HIV status Occupational Health and Safety Act Right to a safe working environment
  92. 92. Legislation within the workplace LAW RIGHT Compensation for Occupational Injuries and Disease Act (COIDA) Right to certain basic standards of employment, including 6 weeks of paid sick leave year a 3 year period Basic Conditions of Employment Act Right to certain basic standards of employment, including 6 weeks of paid sick leave over a 3-year period Medical Schemes Act Right to no unfair discrimination in giving employee benefits Common Law Right Right to privacy about your HIV status at work
  93. 93. MONITORING and EVALUATION?
  94. 94. Reporting  Detailed  Applicable  Appropriate  Per intervention / monthly / annual  Integrate with other statistics: - Absenteeism - Disability - Deaths
  95. 95. Reports  1st / 2nd / 3rd time testing  Date tested +  Registration CD4+ count, FBC, LFTS,UA,  Increased adherence  Therapy type  Pathology markers  Trends  Outcomes (PEP & PMTCT)
  96. 96. Monitor and Evaluate Measurement of objective outcomes is essential to plan future strategies, optimal resource utilisation and identify possible areas of improved interventions A MAJOR TOOL FOR THE CHAMPIONS
  97. 97. Recommendations  Flexible and customised  Outcomes driven  Holistic approach  Wellness approach  Integrated approach  Health Seeking behaviour  Partnerships  Community resources  Medical insurance
  98. 98. Recommendations  In line with Department of Health objectives  Trends  Monitoring and Evaluation  Increased accuracy of statistics  Accurate and appropriate rapports and feedback  Protect human capital
  99. 99. HIV life cycle PREVENTION PROGRAMME BEHAVOIUR CHANGE HEALTH RISK MANAGEMENT PROGRAMME
  100. 100. YES WE CAN!!!!! CONVERT HIV & AIDS CRISIS INTO AN OPPORTUNITY??
  101. 101. THE ROAD AHEAD NOW?
  102. 102. Thank you

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