Effects of HIV scale-up programs on delivery of routine health care in public health laboratories: Case of New Nyanza Provincial General Hospital in Kisumu, Kenya
While the HIV/AIDS epidemic has severely strained vulnerable health systems in developing countries, HIV scale-up has attracted unprecedented attention and resources that have helped to strengthen these health systems. In recent years, policymakers and medical experts have expressed alarm that delivery of quality health care in resource limited settings is a challenge with health policy, management and service delivery level constraints all playing an important role. There is need for resources to be channeled in the implementation of quality programs that will help to improve the quality of health care for patients through the reduction of testing errors and decrease in poor quality treatment. This study aimed to identify priority research questions regarding the effect of HIV scale-up on key elements of health systems in the delivery of routine health care in the New Nyanza Provincial General Hospitallaborator y, (NNPGH) a public health laboratory in Kisumu, Kenya. The objective of this study was to examine how service delivery factors, leadership factors, health workforce factors and healthinformation systems factors as aspects of HIV scale-up programs affect delivery of routine health care at the New Nyanza Provincial General Hospital, Kisumu. As a knowledge gap, there is a need to improve capacity to diagnose health systems constraints. Secondly, public health institutions should seek more active and consistent engagement in overall sector policy processes and strategies. The study adopted a descriptive survey design with a quantitative approach to data collection. Using probability and non-probability sampling techniques, a sample of 414 respondents drawn from 3000 patients and 61 staff was studied. Data analysis entailed use of both descriptive and inferential statistics. SAS version 9.2 software was used to run frequency distributions. Pearson's Chi-square test was used in determining the association between the variables and preparation for hypothesis testing to generate significant test results. Quantitative analysis was integrated into one main study report and the study findings were presented in tables. Study findings indicated that HIV scale-up has improved service delivery through infrastructure upgrades in the laboratory, non-HIV services have benefited positively due to the scale-up and improved access and delivery of better health care services at the NNPGH laboratory. The study results also found that through HIV scale-up, leadership has contributed to better delivery of care by improved protection of patients' privacy and confidentiality. HIV scale-up has affected the health workforce adversely by placing considerable additional pressures on health personnel in the public health laboratories due to poor retention, increased workload and longer turnaround time for the patients due to the increased workload. Findings also revealed that the scale-up has positively affected the delivery of care through introduction of useful laboratory data management systems for management of records. The study concluded that HIV scale-up is having both positive and negative effects in the delivery of care at the NNPGH laboratory and that appropriate policies to retain staff in the public health sector may need to be tailored. Key recommendations made include paying attention to supporting patient retention, data quality and quality of care in order to measure changes in the systems put in place to support quality services and adherence to standards. It is also recommended that efforts should focus on building the basic evidence base for evaluating the broader impact of HIV scale-up, and operational research should examine strategies for ensuring that the resources, innovations and energy associated with HIV scale-up help to strengthen health systems. Proposed areas for further research include forging strategic partnerships among health sector service providers (including the public sector, civil society and the private sector) and with other sectors to help develop and implement national HIV responses.
University of Nairobi, Kenya