Determination of competency levels for the management of HIV/AIDS among qualified health workers, in Chibombo District

Abstract

INTRODUCTION: Chibombo district is situated in rural Zambia and HIV/AIDS was established as the district’s leading cause of mortality, which accounted for 20% of all deaths (Goma et al., 2013) and it was one of the major health challenges experienced in the district, according to the Chibombo District Health Management Team (DHMT) report , 2010.The report stated that the expansion of provision of comprehensive HIV/AIDS services in a rural area like Chibombo requires additional health workers at all levels of care. Though this is a challenge for the whole country, the shortage of healthcare personnel is particularly acute in rural areas, where more than half of the health centers employ only one qualified staff member and many function without any trained health workers (Ministry of Health, Human Resources for Health Strategic Plan, 2005).The aim of this study was to determine the distribution of HIV/AIDS management, competency levels among the health workers in Chibombo district, as well as to establish the factors that influenced the level of competence of the health workers in the district.METHODS: This study was a cross sectional descriptive study design using both quantitative and qualitative data. The quantitative data was obtained from the analysis of secondary data from the study, ‘Evaluating the Availability of Adequately Trained Health care Providers in Rural Zambia through competency assessment and outcome mapping ’(Goma et al., 2013).The level of competence was determined from a self-assessment questionnaire based on the competency based health human resources planning framework. A competence level of 75% and above was considered competent, and any competence level below 75% was considered as not competent. A total of 21 health workers were interviewed. For the qualitative part of the study, in depth interviews with key informants from the Chibombo District Health Management Trust were conducted to find out if the health workers in Chibombo district were competent, and the factors that affect their level of competence. The interviews were recorded, transcribed and interpreted based on common themes evident in all the interviews.RESULTS: Liteta District hospital, had competent health workers, some of whom scored above 80% (the medical doctors) in competence level. The other health workers interviewed from the 3 rural health facilities were not competent in HIV/AIDS management and care, apart from one clinical officer in Chipembi who scored above 80%. The District hospital had the adequate number of health workers in the facilities, whereas all the 3 rural health facilities had critical health workers missing like a laboratory technician and pharmacy technician. The factors that affected the levels of competence in Chibombo were intrinsic factors, such as; lack of training in HIV/AIDS management ,inadequate undergraduate level training, absence of in-house training, lack of concentration & practice, failure to consult with other colleagues, failure to read in order to update skills. Extrinsic factors such as a centralized system of management, (government decides on health worker posting and not on District recommendations or requirements), serious shortage of staff, patient overload, general hardships and personal challenges like poor living quarters, lack of electricity, dilapidated living quarters, long distance to banks, bad road infrastructure, lack of tools, or equipment, interference from chiefs, lack of appreciation from patients -affected the levels of competence that were measured.CONCLUSIONS: In Chibombo district, Liteta district hospital had a proper mix of health workers who were skilled and competent enough to provide adequate HIV/AIDS management and care, whereas the majority of the RHC’s and Health post staff were not competent. All of the RHC’s lacked some of the critical health workers needed in order for the facility to effectively manage HIV/AIDS as a health team.