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How does HIV and SRH service integration impact upon workload?

Summary: There is evidence to suggest the potential to improve productivity through integration, however there are significant challenges and the pace of productivity gain slow.

Detail: There is growing interest in integration of HIV and sexual and reproductive health (SRH) services as a way to improve the efficiency of human resources (HR) for health in low- and middle-income countries. Although this is supported by a wealth of evidence on the acceptability and clinical effectiveness of service integration, there is little evidence on whether staff in general health services can easily absorb HIV services.

To answer this question a descriptive analysis of HR integration through task shifting/sharing and staff workload was conducted. The level, characteristics and changes in HR integration were described in the context of wider efforts to integrate HIV and SRH, and the impact of HR integration on staff workload were explored.

It was found that improvements in the range of services provided by staff (HR integration) were more likely to be achieved in facilities which also improved other elements of integration. While there was no overall relationship between integration and workload at the facility level, HIV/SRH integration may be most influential on staff workload for provider-initiated HIV testing and counselling and postnatal care services, particularly where HIV care and treatment services are being supported with extra SRH and HIV staffing. The findings therefore suggest that there may be potential for further efficiency gains through integration, but overall the pace of improvement is slow.

In conclusion, it was found that:

  • Integration was not scaled up uniformly and a readiness assessment should precede integration policy
  • HIV and SRH integration may be most influential on staff workload for provider initiated counselling and testing, postnatal care and sexual transmitted infection services
  • Some of these increases, in particular increased staffing of HIV-related services, may have come at the cost of reductions of staff available for other services such as PNC, and lead to greater imbalances in staff workload within a facility
  • However, policy makers should also be careful about overworking staff and assess integration in the broader context of HR planning

As a result it is recommended that any efforts to implement integration are fully assessed in the broader context of human resources planning, both within and between facilities. This will create better understanding of the impact on different cadres and minimise displacement effects, in order to ensure that neither staff nor patients are negatively impacted by integration policy.

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