HIV This Week

Kaboru BB, Muchimba M, Falkenberg T, Höjer B, Faxelid E; The Bridging Gaps Research Team. Quality of STIs and HIV/AIDS care as perceived by biomedical and traditional health care providers in Zambia: Are there common grounds for collaboration? Complement Ther Med. 2008 Jun;16(3):155-162.

Kaboru and colleagues aimed to explore biomedical and traditional health care providers’ perceptions of good quality of care and opinions on weaknesses in the services they provide to patients with HIV and other sexually transmitted infections. Using data from a cross-sectional survey, the authors post-coded two open-ended questions related to biomedical and traditional health care providers’ perceptions on good quality of care and on provided care. The post-coding was done following Donabedian’s framework of assessment of quality of care and allowed transformation of qualitative data into quantitative. The analysis is based on comparison of frequencies, proportions, and subsequent chi-square tests and odds ratios. The study set in Ndola and Kabwe, Zambia measured proportions of responses from 152 biomedical and 144 traditional health care providers. Substantial proportions of providers from both sectors perceived drugs availability (63% of biomedical and 70% of traditional health care providers) and welcoming attitude (73% of biomedical and 64% of traditional health care providers) as important components of good quality care. Biomedical health care providers were more likely than traditional health care providers to mention proper examination, medical management (provider’s technical ability) and explanation of causes and prognosis of the disease as important. More traditional health care providers than biomedical ones cited short waiting time and cost of care. A majority of biomedical health care providers (87%) and of traditional health care providers (80%) reported deficiencies in their sexually transmitted infection- and HIV-related services. Both groups regarded training of providers and nutritional support and health education to patients as lacking. None of the traditional health care providers alluded to voluntary counselling and testing or supportive/home-based care as aspects needing improvement. Drugs availability and welcoming attitude were two aspects of quality highly valued by biomedical and traditional health care providers. Future collaborative interventions need to respond to aspects of joint concern including training of providers, nutritional support, and health education to patients. Further, there is an imperative of expanding and adapting voluntary counselling and testing, home-based care and palliative care to traditional health care providers for better care of HIV and other sexually transmitted infections.

Editors’ note: This study comparing the views of both traditional and biomedical care providers provides food for thought on how to improve quality of care for patients who access either or both types of providers. Better collaboration for joint health action in the community could reduce drug interactions, decrease costs for patients, and enhance the comparative contribution of each type of provider.

Continued political and civil unrest in low-resource countries underscores the ongoing need for specialised reproductive health services for displaced people. Displaced women particularly face high maternal mortality, unmet need for family planning, complications following unsafe abortion, and gender-based violence, as well as sexually transmitted diseases, including HIV. Relief and development agencies and UN bodies have developed technical materials, made positive policy changes specific to crisis settings and are working to provide better reproductive health care. Substantial gaps remain, however. The collaboration within the field of reproductive health in crises is notable, with many agencies working in one or more networks. The five-year RAISE Initiative brings together major United Nations agencies and non-governmental organisations from the fields of relief and development, and builds on their experience to support reproductive health service delivery, advocacy, clinical training and research. The readiness to use common guidance documents, develop priorities jointly and share resources has led to smoother operations and less overlap than if each agency worked independently. Trends in the field, including greater focus on internally displaced persons and those living in non-camp settings, as well as refugees in camps, the protracted nature of emergencies, and an increasing need for empirical evidence, will influence future progress.

Editors’ note: The RAISE (Reproductive Health Access, Information, and Services in Emergencies) Initiative is a partnership with a long-term perspective (2006-2011) of Columbia University and Marie Stopes International with United Nations, humanitarian, and development organisations. RAISE and other networks arose from the collaborative work of 40 UN, government, and non-governmental organisations that formed the Inter-Agency Working Group on Reproductive Health in Crises (IAWG) in 1995. Since collaborative work across this field has been long lasting and productive, it is useful to examine what underpinned both the trends and key advances.