Effects of Service Integration on Utilisation, Coverage and Workload - A Ugandan Case Study of the Integration of Prevention of Mother to Child Transmission of HIV and Maternal, Neonatal and Child Health Related Services
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Introduction: Following global calls to integrate the delivery of Sexual Reproductive Health (SRH) and HIV/AIDS services efforts have been focused on adopting innovative approaches to respond to the calls. These calls were premised on the belief that delivery of integrated services leads to increase in service availability, access, utilisation as well as efficiency in service delivery. In Uganda, updating of health policies and guidelines are still ongoing so as to facilitate delivery of integrated SRH and HIV/AIDS services.
Objectives: This study examined effects of integration of Prevention of Mother to Child Transmission of HIV (PMTCT) and Maternal, Neonatal and Child Health (MNCH) on service utilisation and coverage along the PMTCT and MNCH service continuum and assessed midwives’ workload in three (3) districts in Uganda.
Methods and Analysis: A multi-phased, mixed methods design was used. Phase I: policy and document review through content analysis; phase II: quantitative assessment of i) trends in service utilisation and using student T tests and segmented regression analysis ii) clients utility of integrated services iii) midwives workload assessed using Workload Indicators of Staffing Need (WISN) software. Phase III: key informant interviews (KIIs) of key stakeholders and observations using content analysis. A combination of Roger’s diffusion of innovation and health systems frameworks were used as the analytical frameworks.
Key Findings: Policy environment in Uganda supports integration of PMTCT and MNCH services. Significant increase in utilisation and coverage was observed for HIV+ infants tested for HIV+ (PCR): p
Conclusion: Health programs if well integrated leads to increase in service utilization. Rate of increase is dependent on utilisation levels of the service into which the new service is being added. Whereas immediate benefits can be observed when services are integrated in pilot studies, integration within primary health care system is a lengthy process, implying that integration effects occur gradually as services get better integrated and systems barriers addressed.