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Table 1 Health centre demographic information & features of HIV service scale up

From: The impact of human immunodeficiency virus (HIV) service scale-up on mechanisms of accountability in Zambian primary health centres: a case-based health systems analysis

Demographic features Health centre 1 Health centre 2 Health centre 3 Health centre 4
Designation Urban Rural Urban Peri-Urban
Official catchment population* 62,579 15,000 101,972 43,850
Official opening hours* Day: 8:00–17:00 Day: 8:00–17:00 Day: 8:00–17:00 Day: 8:00–17:00
Night: 17.30–7.30 Night: 17.30–7.30 Night: 17.30–7.30 Night: 17.30–7.30
Service departments** OPD, MCH,TB, ART, LAB, EH OPD, MCH,TB, ART, IPD, LAB, LABOUR, EH OPD, MCH,TB, ART, LAB, EH OPD, MCH,TB, ART, IPD, LAB, LABOUR, EH
Professional staff* 41 5 46 22
Lay staff*^ 29 5 46 12
Common features of ART clinic establishment (c. 2005–2008) • New stand-alone building for ART clinic in three sites (HC1, HC3, HC4)
• Externally funded/supported supply chain & laboratory services
• Recruitment & training of adult & peadiatric peer educators/Establishment of peer support groups
• NGO funded/run in-service training for select professional staff
• Donor-funded ‘overtime’ payments for professional staff working in the ART clinics
• NGO supported quality assurance systems
• Electronic medical records in three sites (HC1, HC3, HC4); ART specific stationary at all sites.
Common features of ART clinic scale-up & transition (c. 2009–2011) • Removal of donor-funded overtime payments
• Scale up of MoH-run HIV in-service training for all professional staff
• Formal inclusion of ART clinic services in routine duties of all professional staff
• Scale-back in NGO support for lay personnel (including peer educators & defaulter tracing)
• Scale-back in NGO support for quality assurance programs
• Externally funded but MOH managed ART supply chain
Common effects of ART clinic on facility operations & relationships • Improved infrastructure & technical capacity to deliver ART.
• Early improvements in HCW motivation and clinical standards in ART department.
• Lay personnel enabled efficient administrative & non-clinical functions in ART department.
• Early intra-cadre jealousies around opportunities for HIV training, overtime payments and better work conditions in ART clinics.
• Additional fragmentation (stand-alone ART clinics) of health centre management & operations.
• Strong perception amongst providers that HIV services were exceptional to their core duties (especially HC1, HC2, HC3).
• Perceptions that HIV services constituted additional/over work, undermining staff morale and service values.
Particular effects of ART clinic on facility operations & relationships Enduring intra-cadre jealousies around overtime payments & superior work conditions in stand-alone ART clinic continued to undermine provider cooperation & continuity of care between ART clinic and other departments. Small cadre of professional staff frequently overwhelmed by requirements of additional HIV services. Effects exacerbated by weaker supervision & quality assurance afforded to rural (as opposed to urban) sites. Very large patient numbers & decreasing NGO support for lay personnel in scale-up phase led to marked decline in administrative functionality (e.g. missing files; queue bunching) and frequent patient-provider confrontations. Overall in-charge able to use early gains in performance standards & staff morale in ART clinic to strengthen overall operations via whole-of-clinic meetings/integrated OPD/ART service delivery as levers.
  1. *At the time of study.
  2. **OPD = Outpatient Department; MCH = Maternal and Child Health department; TB = Tuberculosis treatment department; ART = antiretroviral therapy clinic; LAB = laboratory; EH = Environmental Health department; IPD = Inpatient Department; LABOUR = labour ward.
  3. ^Includes paid or stipendiary lay staff with a formal terms of reference; does not include ad hoc voluntary lay staff.