The quality of rapid HIV testing in South Africa: an assessment of testers’ compliance

Background: The aim of this study was to assess the quality of rapid HIV testing in South Africa.Method: A two-stage sampling procedure was used to select HCT sites in eight  provinces of South Africa. The study employed both semi-structured interviews with HIV testers and observation of testing sessions as a means of data collection. In total, 63 HCT sites (one HIV tester per site) were included in the survey assessing qualification, training, testing practices and attitudes towards rapid tests.  Quantitative data was analysed using descriptive statistics and qualitative data was content analysed. Results: Of the 63 HIV testers, 20.6% had a nursing qualification, 14.3% were professional counsellors, 58.7% were lay HIV counsellors and testers and 6.4% were from other professions. Most HIV testers (87.3%) had had a formal training in testing, which ranged between 10-14 days, while 6 (9.5%) had none. Findings revealed sub-standard practices in relation to testing. These were mainly related to non-adherence to testing algorithms, poor external quality control practices, poor handling and communication of discordant results.Conclusion: Quality of HIV rapid testing may be highly compromised through poor adherence to guidelines as observed in our study.Keywords: HIV rapid testing, quality, health workers, quality assuranc

Quality of HIV counselling in South Africa

HIV counselling and testing (HCT) has become increasingly available in South Africa since the 1990s. Over 4500 public health facilities offer client and provider-initiated HIV counselling and testing. Counselling and testing remain key components of HIV/AIDS prevention as they provide an entry point into prevention, care, treatment and support services. This paper examines the quality of HIV counselling in government and non-governmental (NGO) facilities and reviews adherence to the HCT policy guidelines during counselling sessions in 67 HIV counselling and testing (HCT) sites across 8 South African provinces.The assessment used both quantitative and qualitative methods. In total 149 structured observations of counselling sessions were conducted using a written checklist and audio recording. This assessment confirms that while counselling does occur prior and post HIV testing, the quality of counselling differs between sites and does not match the South African HCT policy guidelines. The following key aspects were not adequately discussed with clients: risk assessment and reduction, partner involvement, supportive care and treatment for those testing HIV positive. Confidentiality was also compromised by frequent interruptions during some sessions. The assessment indicated that ongoing training and mentoring of counsellors needs to be addressed, to make the HCT programme more effective.IBS

Comparing the Job Satisfaction and Intention to Leave of Different Categories of Health Workers in Tanzania, Malawi, and South Africa.

Job satisfaction is an important determinant of health worker motivation, retention, and performance, all of which are critical to improving the functioning of health systems in low- and middle-income countries. A number of small-scale surveys have measured the job satisfaction and intention to leave of individual health worker cadres in different settings, but there are few multi-country and multi-cadre comparative studies. The objective of this study was to compare the job satisfaction and intention to leave of different categories of health workers in Tanzania, Malawi, and South Africa. We undertook a cross-sectional survey of a stratified cluster sample of 2,220 health workers, 564 from Tanzania, 939 from Malawi, and 717 from South Africa. Participants completed a self-administered questionnaire, which included demographic information, a 10-item job satisfaction scale, and one question on intention to leave. Multiple regression was used to identify significant predictors of job satisfaction and intention to leave. There were statistically significant differences in job satisfaction and intention to leave between the three countries. Approximately 52.1% of health workers in South Africa were satisfied with their jobs compared to 71% from Malawi and 82.6% from Tanzania (χ2=140.3, p<0.001). 18.8% of health workers in Tanzania and 26.5% in Malawi indicated that they were actively seeking employment elsewhere, compared to 41.4% in South Africa (χ2=83.5, p<0.001). The country differences were confirmed by multiple regression. The study also confirmed that job satisfaction is statistically related to intention to leave. We have shown differences in the levels of job satisfaction and intention to leave between different groups of health workers from Tanzania, Malawi, and South Africa. Our results caution against generalising about the effectiveness of interventions in different contexts and highlight the need for less standardised and more targeted HRH strategies than has been practised to date

Understanding informal payments in health care: motivation of health workers in Tanzania

<p>Abstract</p> <p>Background</p> <p>There is growing evidence that informal payments for health care are fairly common in many low- and middle-income countries. Informal payments are reported to have a negative consequence on equity and quality of care; it has been suggested, however, that they may contribute to health worker motivation and retention. Given the significance of motivation and retention issues in human resources for health, a better understanding of the relationships between the two phenomena is needed. This study attempts to assess whether and in what ways informal payments occur in Kibaha, Tanzania. Moreover, it aims to assess how informal earnings might help boost health worker motivation and retention.</p> <p>Methods</p> <p>Nine focus groups were conducted in three health facilities of different levels in the health system. In total, 64 health workers participated in the focus group discussions (81% female, 19% male) and where possible, focus groups were divided by cadre. All data were processed and analysed by means of the NVivo software package.</p> <p>Results</p> <p>The use of informal payments in the study area was confirmed by this study. Furthermore, a negative relationship between informal payments and job satisfaction and better motivation is suggested. Participants mentioned that they felt enslaved by patients as a result of being bribed and this resulted in loss of self-esteem. Furthermore, fear of detection was a main demotivating factor. These factors seem to counterbalance the positive effect of financial incentives. Moreover, informal payments were not found to be related to retention of health workers in the public health system. Other factors such as job security seemed to be more relevant for retention.</p> <p>Conclusion</p> <p>This study suggests that the practice of informal payments contributes to the general demotivation of health workers and negatively affects access to health care services and quality of the health system. Policy action is needed that not only provides better financial incentives for individuals but also tackles an environment in which corruption is endemic.</p

Haydom Lutheran Hospital - Final project review

Haydom Lutheran Hospital (HLH) is a first level referral hospital located in Mbulu district, Manyara region in Tanzania. HLH was established by the Norwegian Lutheran Mission in 1955 and is owned by the Evangelical Lutheran Church of Tanzania (ELCT). HLH has over many years received substantial financial support from the Norwegian government through the Ministry of Foreign Affairs and NORAD. The support is presently channelled through the Royal Norwegian Embassy (RNE) in Dar es Salaam. In 2008, the RNE funded 70% of the hospital’s budget. Most of the RNE funds are administered through a Block Grant. This report is the final project review of the Block Grant for the period 2006-2009. Emphasis is placed on developments since the mid-term review, which was conducted in late 2007

Haydom Lutheran Hospital - Final project review

Haydom Lutheran Hospital (HLH) is a first level referral hospital located in Mbulu district, Manyara region in Tanzania. HLH was established by the Norwegian Lutheran Mission in 1955 and is owned by the Evangelical Lutheran Church of Tanzania (ELCT). HLH has over many years received substantial financial support from the Norwegian government through the Ministry of Foreign Affairs and NORAD. The support is presently channelled through the Royal Norwegian Embassy (RNE) in Dar es Salaam. In 2008, the RNE funded 70% of the hospital’s budget. Most of the RNE funds are administered through a Block Grant. This report is the final project review of the Block Grant for the period 2006-2009. Emphasis is placed on developments since the mid-term review, which was conducted in late 2007

Informal payments and the quality of health care: Mechanisms revealed by Tanzanian health workers

Informal payments for health services are common in many transitional and developing countries. The aim of this paper is to investigate the nature of informal payments in the health sector of Tanzania and to identify mechanisms through which informal payments may affect the quality of health care. Our focus is on the effect of informal payments on health worker behaviours, in particular the interpersonal dynamics among health workers at their workplaces. We organised eight focus groups with 58 health workers representing different cadres and levels of care in one rural and one urban district in Tanzania. We found that health workers at all levels receive informal payments in a number of different contexts. Health workers sometimes share the payments received, but only partially, and more rarely within the cadre than across cadres. Our findings indicate that health workers are involved in 'rent-seeking' activities, such as creating artificial shortages and deliberately lowering the quality of service, in order to extract extra payments from patients or to bargain for a higher share of the payments received by their colleagues. The discussions revealed that many health workers think that the distribution of informal payments is grossly unfair. The findings suggest that informal payments can impact negatively on the quality of health care through rent-seeking behaviours and through frustrations created by the unfair allocation of payments. Interestingly, the presence of corruption may also induce non-corrupt workers to reduce the quality of care. Positive impacts can occur because informal payments may induce health workers to increase their efforts, and maybe more so if there is competition among health workers about receiving the payments. Moreover, informal payments add to health workers' incomes and might thus contribute to retention of health workers within the health sector.Informal payments Corruption Quality of health care Health worker Performance Tanzania

Haydom Lutheran Hospital - Final project review

Haydom Lutheran Hospital (HLH) is a first level referral hospital located in Mbulu district, Manyara region in Tanzania. HLH was established by the Norwegian Lutheran Mission in 1955 and is owned by the Evangelical Lutheran Church of Tanzania (ELCT). HLH has over many years received substantial financial support from the Norwegian government through the Ministry of Foreign Affairs and NORAD. The support is presently channelled through the Royal Norwegian Embassy (RNE) in Dar es Salaam. In 2008, the RNE funded 70% of the hospital’s budget. Most of the RNE funds are administered through a Block Grant. This report is the final project review of the Block Grant for the period 2006-2009. Emphasis is placed on developments since the mid-term review, which was conducted in late 2007