ABSTRACT
Objectives: The objective was to assess improvement; or lack thereof; in the uptake of prevention of mother-to-child transmission (MTCT) services at selected sites supported sites by the Global HIV/AIDS Initiative Nigeria (GHAIN).Design: The study used aggregated monthly service statistics to evaluate service improvement efforts that were conducted before and after these were undertaken between July 2007-June 2008. Settings and subjects: The service improvement efforts took place in 60 public healthcare facilities. Outcome measures: The study measured changes in the number of pregnant women who attended antenatal clinics for the first time; the number of pregnant women tested for human immunodeficiency virus (HIV); the number of HIV-positive women receiving antiretroviral (ARV) prophylaxis; and the service ratio; an indicator of the relative uptake of ARV prophylaxis. An estimate of MTCT events that were averted through ARV prophylaxis taken by the pregnant women was also calculated. Results: One hundred and twenty thousand; five hundred and thirty-seven women attended an antenatal clinic (ANC) for the first time. There was an average of 167.4 monthly attendances per facility. ANC attendance increased per facility by 11.1 women monthly post-intervention (p-value 0.01). The uptake of HIV testing was 87; with a monthly average increase of 17.8 women tested per facility (p-value 0.01). ARV prophylaxis uptake rose from 3.3-5.4 women per facility per month (p-value 0.01). The service ratio per facility improved from 5.3 women receiving ARVs to 6.5 for every 10 women who tested positive for HIV (p-value 0.01). Applying risk reduction estimates of different ARV regimens; it was estimated that between 88-169 MTCT events were averted pre-intervention; and 143-276 events; post-intervention. Conclusion: Service improvement intervention improved the utilisation of PMTCT services. It should be a key intervention that is used to close the PMTCT gap in Nigeria
Subject(s)
Anti-Retroviral Agents/therapeutic use , Disease Transmission, Infectious , HIV InfectionsABSTRACT
Objectives: This study explored major factors that influenced staff motivation at a district hospital in South Africa following hospital reforms and comparison of these factors across the two main staff categories. Design: This study was a cross-sectional descriptive survey. Settings and subjects: This study included all medical and nursing staff working at the district hospital. Outcome measures: A semi-structured questionnaire coded for anonymity was used. It comprised three sections: the introduction; demographic information and a list of factors to which participants responded by indicating their level of agreement or disagreement using the Likert's scale. The questionnaire's reliability was confirmed using Cronbach's coefficient alpha with a value of 0.9. Results: Of the 179 participants; 122 returned the questionnaires. This equated to a response rate of 68. The staff expressed more demotivation than motivation. Major factors that played a role were institutional in character; namely poor management and leadership; unfavourable institutional policies and administration practices with regard to staff development; conflictual inter- and intraprofessional relationships; a paucity of equipment and retention and recruitment strategies. The unique motivator was the individual value of the vocational aspect of the profession. Distance travelled to the workplace did not have any association with the identified motivating and demotivating factors. Conclusion: Staff mo tivation is crucial in any institution or organisation. Presently; the South African healthcare sector is undergoing transformation in terms of implementation of National Health Insurance. The effectiveness of the healthcare system in achieving its goals will be impacted by the prioritisation of institutional strategies that contribute to staff motivation. Managers' skills in healthcare facilities are critical to the success of the implementation of reforms in South Africa