Antiretroviral therapy in a South African public health care setting – facilitating and constraining factors

Abstract

The objective of the study was to identify and document facilitating and constraining factors in the antiretroviral therapy (ART) programme in a public health care setting in the Eastern Cape, South Africa. Observations for the study were carried out in a district hospital and two down-referral clinics in Makana Local Services Area in the Eastern Cape Province. Two discussion groups with key stakeholders were conducted to gather information about opinions and experiences among the health care providers (HCPs). It was found that the operating ART programme in this setting has been integrated in the existing down-referral health care system, based on follow-up in primary health care (PHC) clinics. Treatment is provided free of charge. The treatment programme provides the patients with access to counselling, nutritional assistance, psychosocial support and social welfare evaluation. However, increasing patient numbers and lack of human resources leads to a heavy workload for the HCPs involved with the ART programme. The need for additional, educated health workers is a major constraint for progress in provision of health care to patients who have accepted their HIV status, and are enrolled, or waiting to be enrolled, on the ART. However, delegation of work tasks among available HCPs and good communication between HCPs in the different clinics is a facilitating factor that ensures efficient use of the human resources available. Conclusion: Taking into account the challenges in a resource-constrained setting, this programme shows potential for functioning well as a provider of ART for those who are able and willing to access it. Considering an already heavy workload for HCPs, limitations and challenges still exist in reaching out with adequate treatment to a greater number of people who need ART