Task shifting or shifting care practices? The impact of task shifting on patients’ experiences and health care arrangements in Swaziland
| Autor: | Thandeka Dlamini-Simelane, Eileen Moyer |
|---|---|
| Přispěvatelé: | Anthropology of Health, Care and the Body (AISSR, FMG) |
| Jazyk: | angličtina |
| Předmět: |
medicine.medical_specialty
Health Personnel Global health Context (language use) HIV Infections Workload Health informatics Ambulatory Care Facilities Health administration Interviews as Topic 03 medical and health sciences 0302 clinical medicine Nursing Health care medicine Humans 030212 general & internal medicine Anthropology Cultural business.industry Expert clients 030503 health policy & services Public health Nursing research Health Policy Monitoring and evaluation Public relations Continuity of Patient Care Task-shifting 3. Good health Patient friendly services Anti-Retroviral Agents Implementation science Swaziland 0305 other medical science business Eswatini Research Article |
| Zdroj: | BMC Health Services Research BMC Health Services Research, 17:20. BioMed Central |
| ISSN: | 1472-6963 |
| DOI: | 10.1186/s12913-016-1960-y |
| Popis: | BackgroundIn the quest to achieve early HIV treatment goals, national HIV treatment programmes dependent on international funding have been dramatically redesigned over the last 5 years. Bottlenecks in treatment provision are conceived of as health system problems to be addressed via structural and logistical fixes (routine HIV testing, point-of-care equipment, nurse-led antiretroviral treatment initiation, and patient tracking). Patient perspectives are rarely taken into account when such fixes are being considered. Patients’ therapeutic experiences often remain at the periphery during the planning stage and are only considered within the context of monitoring and evaluation audits once programmes are up and running.MethodsEthnographic research was conducted in five clinics in Swaziland between 2012 and 2014. Participatory approaches were used to collect data; the first author trained as an HIV counsellor in order to collect observational data on the continuum of care, and conducted in-depth interviews with interlocutors involved at the different phases.ResultsAlthough recently adopted global HIV strategies have proven effective in scaling up treatment in Swaziland, our research demonstrates that the effort to expand services rapidly and to meet donor targets has also undermined patients’ therapeutic experiences and overtaxed health workers, both of which are counterproductive to the ultimate goal of treatment scale-up. This article provides a perspective beyond the structural elements that impede universal treatment, and explores patient views and experiences of the strategies adopted to support further treatment expansion, with a particular focus on the shifting of key care and logistical tasks to expert clients.ConclusionWe argue that in the quest to achieve universal early access to treatment, both donors and states must go beyond strengthening health systems and strive to enhance the quality of patient experiences and take seriously health worker limitations. |
| Databáze: | OpenAIRE |
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