Private-for-profit HIV/AIDS Care in Uganda: An Assessment: Nearly half of Uganda’s health care facilities are private and for-profit, and a small percentage has been accredited to provide care and treatment to people with HIV/AIDS. However, little is known about the quality of care offered by private-for-profit (PFP) providers. This study assessed 30 of the 36 accredited PFP providers in Uganda to determine the scope and quality of their HIV/AIDS services. A major finding of the assessment was that PFP provider adherence with standards of care was good in the first visit, particularly for clinical activities, but declined over time; provider adherence to standards was also generally higher for ART services that for pre-ART care. The assessment found that recordkeeping, essential for care of a long-term illness, was poor: Of 1500 patient records sought, only 371 were located. Finally, patient retention in care was also poor: Of the 210 ART patients whose records were assessed, 93% were still in care after one month, 86% after three months, 76% after six months, but only 66% after nine months. After the initial visit, pre-ART patients returned to the facility a median of four times in the next 12 months, well short of the Ministry’s recommendation that a patient return monthly. Moreover, rates for starting eligible patients are ART were also low: 21% of pre-ART patients became eligible in the second six months after registration on the basis of CD4 count, but only 20% of them started ART. The study recommended that PFPs receive support to enable them to regularly measure and report on indicators of patient retention, adherence with standards, and patient outcomes and to use these data to improve care. (Full report: 30 pages, including study instruments; technical report summary: 7 pages.)
Kenya: Assessment of Health Workforce Competency and Facility Readiness to Provide Quality Maternal Health Services: This report presents the findings of a 2006 assessment of three types of facilities that provide maternal and newborn care in six representative districts in Kenya. Providers were given a 50-question knowledge test, and their skills were assessed as they performed five delivery and neonatal procedures on anatomical models: active management of the third stage of labor (AMTSL), manual removal of the placenta, bimanual uterine compression, immediate newborn care, and neonatal resuscitation with ambu bag. Facilities were assessed in the areas of human resources, infrastructure, care standards, and drugs and equipment. The report concludes that health provider competency at performing basic, life-saving skills was quite low, and the tendency to refer patients with complications was all too common despite weak referral and counter-referral mechanisms. The findings indicate a need for strengthening, in particular, hand washing practices and bimanual uterine compression skills. Recommended interventions to improve poor skills include competency-based training, supportive supervision, and coaching. The report’s findings also call attention to the need to improve infrastructure at a basic level and ensure availability of all necessary supplies and equipment to ensure safe deliveries in health facilities. Appendices provide the knowledge test and answer key, observation instruments for the skill assessments, the facility assessment instrument, and a list of equipment and supplies needed to perform the entire assessment. Download report. 43 pages.
Factors Associated with Adherence to Antiretroviral Therapy in Rwanda: A Multi-site Study: Adherence to antiretroviral therapy (ART) will result in better health outcomes. However, studies investigating such adherence usually examine only part of adherence requirements: They study the number of pills taken, but not whether they were taken in accordance with other requirements, such as taking pills on a schedule and with food requirements. This study, conducted in 2004–2005 in four Rwandan health facilities, found indications that pill combination type was a more important indicator of adherence than the burden of having to take numerous pills. In addition, while 92–98% of study participants reported meeting pill-count requirements, only 69–73% met schedule and food requirements. The report details adherence by treatment type, and the analysis explains associations with such factors as social support and urban versus rural settings.
Download report. 24 pages.
The Evidence Base for Programming for Children Affected by HIV/AIDS in Low Prevalence and Concentrated Epidemic Countries. This working paper is the result of collaboration between the United Nations Children’s Fund (UNICEF) and URC’s Quality Assurance and Workforce Development Project (QAP). Worldwide, the commitment to protect and support children affected by HIV/AIDS is growing, and countries with low level or concentrated epidemics are increasingly developing and putting in place special programs to support these children. The goal of the working paper was to summarize and weigh the evidence on a myriad of challenges faced by children affected by HIV/AIDS in low prevalence and concentrated epidemic countries in order to facilitate evidence-based programming. (142 pages)
Evaluation of Knowledge, Attitudes, and Practices of Health Care Providers toward HIV-positive Patients in Tanzania: This report presents an evaluation of the prevalence and manifestations of stigma and discrimination by Tanzanian health care providers toward people with HIV/AIDS. QAP conducted interviews with providers in three public hospitals in Dar es Salaam to assess stigma and discrimination and their associations with providers’ HIV/AIDS knowledge, their perceived risk of infection, their willingness to care for people with HIV/AIDS, and the availability of protective wear. Most providers expressed at least one negative attitude, such as blame for infection. Discriminatory practices were rare but included selective use of universal precautions, denial of services, substandard treatment, and failure to respect patients’ rights. HIV knowledge was inversely associated with negative attitudes, and providers who feared HIV infection through casual contact had significantly more negative attitudes. In addition, stigma was associated with providers’ selective use of universal precautions. However, these providers willingly provide care to HIV/AIDS patients. The study concludes that HIV-related stigma and discrimination may be attributable to poor HIV related knowledge and fear of infection. It recommends communicative forums and training to allay provider fears and improve understanding of HIV and infection methods.
Download report. (27 pages including survey instrument)
Manual para la humanización y adecuación cultural de la atención del parto (HACAP) [Manual on the Humanization and Cultural Adaptation of Delivery Care]: Developed jointly by QAP, the Ministry of Health of Ecuador, and Family Care International, this manual facilitates a process to adapt delivery care to cultural expectations. It provides guidance for conducting a series of three workshops that bring together health care providers, traditional birth attendants, community leaders, and mothers to discuss cultural practices and preferences and to identify changes that can be made to facility-based delivery care to make institutional delivery more acceptable to expectant mothers. Through role-playing and discussion, participants learn how delivery care is provided at a hospital and by traditional midwives in the community. Those who would change facility-based delivery are allowed to make suggestions, while medical staff have opportunities to consider community preferences and explain to participants any evidence that controverts those preferences. Through the process, hospital staff and midwives come to understand and respect each other’s practices (82 pages including survey instruments; available only in Spanish). Download report. (82 pages including survey instruments; available only in Spanish).
Testing a PMTCT Infant-feeding Counseling Program in Tanzania: This report describes the results of an assessment of job aids and take-home materials that nurse-counselors used in helping expectant mothers select an infant-feeding method. In countries with high rates of HIV/AIDS, such as Tanzania, preventing HIV transmission while at the same time protecting the infant from other potentially fatal conditions, such as diarrhea and malnutrition, is difficult. The tested job aids and take-home materials, available elsewhere on this website, included longer materials that were retained by counselors and brief brochures that counselors used in discussion with mothers and then gave to mothers to keep. By comparing the experiences, knowledge, and behaviors of mothers who were and were not counseled with the aids, the study found that those who used them were better informed and more able to sustain their chosen infant-feeding practices. The report also recommends further consideration of international criteria relating to infant feeding in resource-restrained settings.