Health system response to preventing mother-to-child transmission of HIV policy changes in Zambia: a health system dynamics analysis of primary health care facilities
Background Zambia is focusing on attaining HIV epidemic control by 2021, including eliminating Mother to Child Transmission (eMTCT) of HIV. However, there is little evidence to understand frontline healthcare workers’ experience with the policy changes and the readiness of different health system el...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2022-12-01
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| Series: | Global Health Action |
| Subjects: | |
| Online Access: | http://dx.doi.org/10.1080/16549716.2022.2126269 |
| _version_ | 1797755622325747712 |
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| author | Jonathan Mwanza Mary Kawonga Andrew Kumwenda Glenda E. Gray Wilbroad Mutale Tanya Doherty |
| author_facet | Jonathan Mwanza Mary Kawonga Andrew Kumwenda Glenda E. Gray Wilbroad Mutale Tanya Doherty |
| author_sort | Jonathan Mwanza |
| collection | DOAJ |
| description | Background Zambia is focusing on attaining HIV epidemic control by 2021, including eliminating Mother to Child Transmission (eMTCT) of HIV. However, there is little evidence to understand frontline healthcare workers’ experience with the policy changes and the readiness of different health system elements to contribute to this goal. Objective To understand frontline healthcare workers’ experience of preventing mother-to-child transmission (PMTCT) of human immunodeficiency (HIV) policy changes and to explore the health system readiness to respond to rapid changes in PMTCT policy by using the health system dynamic framework. Method We conducted a qualitative study in which 35 frontline healthcare workers were selected and interviewed using a snowball sampling technique. All transcripts were analysed through thematic content analysis and deductive coding. Themes were derived and presented according to the health system dynamics framework. Results Among the ten elements of the health system dynamics framework, service delivery, context, and resources (i.e. infrastructure and supplies, knowledge and information, human resource, and finance) were critical in implementing the continuously evolving PMTCT policies. Furthermore, due to the fragmented primary health care platform in Zambia, non-governmental organisations (NGOs) were instrumental in ensuring that the PMTCT programme met the demand and requirements of the general population. Frontline healthcare workers who participated in the study described inequity in access to ART services due to the service delivery model employed in the selected study sites. Conclusion The study highlights challenges when policies are implemented without consideration for the readiness, context, and capacity in which the policy is implemented. We offer lessons that can inform implementation of universal health coverage of antiretroviral therapy (ART), a strategy many countries have adopted, despite weak health systems. |
| first_indexed | 2024-03-12T17:49:48Z |
| format | Article |
| id | doaj.art-bb3ee646476b436f9abceeb203c52a47 |
| institution | Directory Open Access Journal |
| issn | 1654-9880 |
| language | English |
| last_indexed | 2024-03-12T17:49:48Z |
| publishDate | 2022-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Global Health Action |
| spelling | doaj.art-bb3ee646476b436f9abceeb203c52a472023-08-03T09:15:31ZengTaylor & Francis GroupGlobal Health Action1654-98802022-12-0115110.1080/16549716.2022.21262692126269Health system response to preventing mother-to-child transmission of HIV policy changes in Zambia: a health system dynamics analysis of primary health care facilitiesJonathan Mwanza0Mary Kawonga1Andrew Kumwenda2Glenda E. Gray3Wilbroad Mutale4Tanya Doherty5University of the WitwatersrandUniversity of the WitwatersrandUniversity of ZambiaSouth Africa Medical Research CouncilUniversity of ZambiaUniversity of the WitwatersrandBackground Zambia is focusing on attaining HIV epidemic control by 2021, including eliminating Mother to Child Transmission (eMTCT) of HIV. However, there is little evidence to understand frontline healthcare workers’ experience with the policy changes and the readiness of different health system elements to contribute to this goal. Objective To understand frontline healthcare workers’ experience of preventing mother-to-child transmission (PMTCT) of human immunodeficiency (HIV) policy changes and to explore the health system readiness to respond to rapid changes in PMTCT policy by using the health system dynamic framework. Method We conducted a qualitative study in which 35 frontline healthcare workers were selected and interviewed using a snowball sampling technique. All transcripts were analysed through thematic content analysis and deductive coding. Themes were derived and presented according to the health system dynamics framework. Results Among the ten elements of the health system dynamics framework, service delivery, context, and resources (i.e. infrastructure and supplies, knowledge and information, human resource, and finance) were critical in implementing the continuously evolving PMTCT policies. Furthermore, due to the fragmented primary health care platform in Zambia, non-governmental organisations (NGOs) were instrumental in ensuring that the PMTCT programme met the demand and requirements of the general population. Frontline healthcare workers who participated in the study described inequity in access to ART services due to the service delivery model employed in the selected study sites. Conclusion The study highlights challenges when policies are implemented without consideration for the readiness, context, and capacity in which the policy is implemented. We offer lessons that can inform implementation of universal health coverage of antiretroviral therapy (ART), a strategy many countries have adopted, despite weak health systems.http://dx.doi.org/10.1080/16549716.2022.2126269health systemprevention of mother-to-child transmission of hiv (pmtct)primary health careartemtctzambia |
| spellingShingle | Jonathan Mwanza Mary Kawonga Andrew Kumwenda Glenda E. Gray Wilbroad Mutale Tanya Doherty Health system response to preventing mother-to-child transmission of HIV policy changes in Zambia: a health system dynamics analysis of primary health care facilities Global Health Action health system prevention of mother-to-child transmission of hiv (pmtct) primary health care art emtct zambia |
| title | Health system response to preventing mother-to-child transmission of HIV policy changes in Zambia: a health system dynamics analysis of primary health care facilities |
| title_full | Health system response to preventing mother-to-child transmission of HIV policy changes in Zambia: a health system dynamics analysis of primary health care facilities |
| title_fullStr | Health system response to preventing mother-to-child transmission of HIV policy changes in Zambia: a health system dynamics analysis of primary health care facilities |
| title_full_unstemmed | Health system response to preventing mother-to-child transmission of HIV policy changes in Zambia: a health system dynamics analysis of primary health care facilities |
| title_short | Health system response to preventing mother-to-child transmission of HIV policy changes in Zambia: a health system dynamics analysis of primary health care facilities |
| title_sort | health system response to preventing mother to child transmission of hiv policy changes in zambia a health system dynamics analysis of primary health care facilities |
| topic | health system prevention of mother-to-child transmission of hiv (pmtct) primary health care art emtct zambia |
| url | http://dx.doi.org/10.1080/16549716.2022.2126269 |
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