Implications of HIV treatment policies on the health workforce in rural Malawi and Tanzania between 2013 and 2017: Evidence from the SHAPE-UTT study

Songo, J. et al. (2021) Implications of HIV treatment policies on the health workforce in rural Malawi and Tanzania between 2013 and 2017: Evidence from the SHAPE-UTT study. Global Public Health, 16(2), pp. 256-273. (doi: 10.1080/17441692.2020.1771395) (PMID:32479141)

Abstract

Effective implementation of policies for expanding antiretroviral therapy (ART) requires a well-trained and adequately staffed workforce. Changes in national HIV workforce policies, health facility practices, and provider experiences were examined in rural Malawi and Tanzania between 2013 and 2017. In both countries, task-shifting and task-sharing policies were explicit by 2013. In facilities, the cadre mix of providers varied by site and changed over time, with a higher and growing proportion of lower cadre staff in the Malawi site. In Malawi, the introduction of lay counsellors was perceived to have eased the workload of other providers, but lay counsellors reported inadequate support. Both countries had guidance on the minimum numbers of personnel required to deliver HIV services. However, patient loads per provider increased in both settings for HIV tests and visits by ART patients and were not met with corresponding increases in provider capacity in either setting. Providers reported this as a challenge. Although increasing patient numbers bodes well for achieving universal antiretroviral therapy coverage, the quality of care may be undermined by increased workloads and insufficient provider training. Task-shifting strategies may help address workload concerns, but require careful monitoring, supervision and mentoring to ensure effective implementation.

• Item Type: Articles
• Additional Information: This work was supported by the Medical Research Council: [grant number MR/P014313/1].
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Crampin, Professor Mia
• Authors: Songo, J., Wringe, A., Hassan, F., McLean, E., Vyas, S., Dube, A., Luwanda, L., Kalua, T., Kajoka, D., Crampin, A., Todd, J., Schouten, E., Seeley, J., Geubbels, E., and Renju, J.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: Global Public Health
• Publisher: Taylor & Francis
• ISSN: 1744-1692
• ISSN (Online): 1744-1706
• Published Online: 01 June 2020
• Copyright Holders: Copyright © 2020 The Author(s)
• First Published: First published in Global Public Health 16(2):256-273
• Publisher Policy: Reproduced under a Creative Commons Licence