Human resources for health strategies adopted by providers in resource-limited settings to sustain long-term delivery of ART: a mixed-methods study from Uganda
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Date
2016
Journal Title
Journal ISSN
Volume Title
Publisher
Human resources for health
Abstract
Human resources for health (HRH) constraints are a major barrier to the sustainability of antiretroviral
therapy (ART) scale-up programs in Sub-Saharan Africa. Many prior approaches to HRH constraints have taken a
top-down trend of generalized global strategies and policy guidelines. The objective of the study was to examine
the human resources for health strategies adopted by front-line providers in Uganda to sustain ART delivery
beyond the initial ART scale-up phase between 2004 and 2009.
Methods: A two-phase mixed-methods approach was adopted. In the first phase, a survey of a nationally
representative sample of health facilities (n = 195) across Uganda was conducted. The second phase involved
in-depth interviews (n = 36) with ART clinic managers and staff of 6 of the 195 health facilities purposively
selected from the first study phase. Quantitative data was analysed based on descriptive statistics, and qualitative data
was analysed by coding and thematic analysis.
Results: The identified strategies were categorized into five themes: (1) providing monetary and non-monetary
incentives to health workers on busy ART clinic days; (2) workload reduction through spacing ART clinic appointments;
(3) adopting training workshops in ART management as a motivation strategy for health workers; (4) adopting
non-physician-centred staffing models; and (5) devising ART program leadership styles that enhanced health
worker commitment.
Conclusions: Facility-level strategies for responding to HRH constraints are feasible and can contribute to
efforts to increase country ownership of HIV programs in resource-limited settings. Consideration of the
human resources for health strategies identified in the study by ART program planners and managers could
enhance the long-term sustainment of ART programs by providers in resource-limited settings.
Description
Keywords
HIV, Health systems, Sustainability, Implementation science, Human resources for health
Citation
Zakumumpa, H., Taiwo, M. O., Muganzi, A., & Ssengooba, F. (2016). Human resources for health strategies adopted by providers in resource-limited settings to sustain long-term delivery of ART: a mixed-methods study from Uganda. Human resources for health, 14, 1-11. DOI 10.1186/s12960-016-0160-5