1. ART Delivery in Health Centres in
Uganda: a Qualitative Assessment of
the Impact on Health Centre Staff
Flavia Zalwango, Celestine Ilakut, Remmie Kimera,
Benson Droti and Janet Seeley
MRC/UVRI Uganda Research Unit on AIDS
5th SAHARA conference, South Africa, 30th November – 3rd December 2009
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2. Overview of presentation
• Background to the study
• Methods
• Findings:
– Before and after ART
– Benefits of rolling out ART to lower health centres
– Challenges of ART delivery
• Discussion and conclusion
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3. Background
ART provision will be rolled-out to
peripheral health centres in Uganda by
Government to:
- Increase equity of access
- reduce burden on higher level centres
- reduce cost to clients of accessing health care
- enhance clients’ adherence to ARVs
•The Wakiso project in Uganda is piloting
ART delivery to health centres to evaluate
the approach.
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4. Aim of the study
To assess the perceived impact on
workloads and working practices of
health centre staff of the roll out of
ART to peripheral government
health centres in Uganda.
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5. Sample
• 14 staff (10 women and 4 men)
involved in ART delivery:
• Selected from 3 health centres (1
rural/2 peri-urban)
• Staff representing different
positions in the health service
(medical assistants/nurses).
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6. Method
• Semi-structured interviews:
– collecting data on:
• career history
• day-to-day tasks before and after
the roll-out of ART to their health
centre.
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7. Analysis
• Thematic content analysis was
used for analysis.
–Data were coded manually by
two research team members,
who discussed and compared
their coding.
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8. Findings
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9. Situation before ART
Work was:
• relatively easier due to clear
allocation of tasks;
• repetitive;
• enjoyable and manageable.
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10. Situation after ART
• Special clinic days for HIV clients
(including PMTCT, community outreach);
• New services such as VCT and Behaviour
Change Communication were introduced;
• Changes in work patterns;
• Time pressure.
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11. “….when the ART programme was
brought into this centre the work that I
was doing here really increased and it
is time consuming. These people that
we come across are not easy because
they expect a lot from us and need
much more attention …”
(female health worker, aged 35)
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12. Benefits of rolling out ART
To the health worker:
• Health worker - client contact increased;
• Relationships with clients and fellow staff
improved;
• Training opportunities available for health
workers;
• Promoted teamwork among health
workers.
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13. “The relationship with patients has
increased because after the
trainings, we the health service
providers are treating the patients
with more attention and care unlike
before and we really keep following
them up just to know how they are
doing.”
(Male health worker, aged 29)
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14. Benefits of rolling out ART
To the clients (as perceived by the
staff):
• Increased access to HIV treatment and
care near their homes;
• Increased contact time with health
workers.
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15. A health worker offering treatment and
support to a client at one of the Health Centres
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16. Challenges of ART delivery
Staff related:
• Lack of mentoring and support;
• Longer working hours;
• Low pay despite increased
responsibilities.
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17. Challenges of ART delivery
Institutional:
• Lack essential drugs;
• Shortage of staff experienced in ART delivery;
• Growing numbers of patients.
Client related:
• Some did not adhere to treatment schedules.
• Poor family planning.
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18. “Many of these mothers come
with very sick children. When
they are clinically observed, most
of them are malnourished and yet
some of the mothers continue
getting pregnant despite the
counselling they receive at the
centre.”
(Female health worker, aged 22)
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19. Discussion
• ART delivery is demanding in terms of
personnel, finances and time.
But
• while challenges remain, the health centre
staff believe that, if supported, they can
deliver ART effectively.
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20. Conclusion
Rolling out ART has:
– Brought services closer to the people;
– Increased contact time between
health workers and clients;
– Increased clients’ access to HIV
treatment and care.
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21. Acknowledgements
• Our thanks to the Evidence for Action
Research Programme Consortium (DFID) and
MRC for funding for this study.
• We are grateful to the staff for giving us their
time.
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