Number/percent of health facilities with the capacity to deliver appropriate care to HIV-infected patients
The number or percent of health care facilities at different levels of the health care system that have the capacity to deliver appropriate palliative care, treatment for opportunistic infections, and referral for HIV-infected patients, according to national guidelines
A health facility survey that includes facility inspection, interviews with service providers, and records reviews assesses health facilities against a standard checklist. The checklist, which will be modified according to local standards, will differ according to the level of the institution within the health care system. It will typically include the availability of trained staff, the adequacy of diagnostic facilities, the adequacy of sanitation, the adequacy of nursing care, procedures for record keeping, preventative counseling, and referral to higher level care and community support organizations as appropriate.
The assessment of “adequate” or “appropriate” conditions and services should follow national guidelines for care of HIV-infected patients. The absence of such guidelines in itself indicates that care and support services for HIV-infected people are likely to be inadequate. However, where they do not exist, one may substitute international standards currently being developed by WHO to determine standards against which to measure facilities.
This indicator excludes the availability of drugs and procedures to prevent accidental transmission of HIV within the health care setting because separate indicators cover this availability.
The indicator is the number of health facilities matching or exceeding the minimum score for adequate capacity to manage HIV-infected patients, divided by the total number of health facilities surveyed. For program purposes, it should be disaggregated by level of health facility as well as by area of service provision.
This indicator is calculated as:
(Number of health care facilities with the capacity to deliver appropriate palliative care, treatment for opportunistic infections, and referral for HIV-infected patients/ Total number of health care facilities) x 100
Assessment by external evaluator of adequacy of care to HIV infected patients
WHO draft protocol for the evaluation of HIV/AIDS care and support; UNAIDS protocol for evaluation of care and support
In the early years of the HIV epidemic, a high proportion of patients with HIV-associated conditions were automatically referred to tertiary level institutions because health services at other levels had neither the trained personnel nor the capacity to cope with them appropriately. Even guidelines on what constituted “appropriate” treatment were rarely available. The constant referral to higher levels of care clearly led to inefficient use of resources within the health system.
In recent years, attempts have been made to ensure that HIV-related conditions are dealt with at appropriate levels within the health system, with referrals in both directions when necessary. Many countries have produced national guidelines to help guide service providers in the appropriate care of HIV-infected patients. Palliative care and treatment for common and minor opportunistic infections may be given at the primary level, while more complex opportunistic infections may be referred to higher levels of the health care system. Referrals should also be made for social and psychological support where appropriate.
This indicator measures the extent to which health services have the capacity to meet treatment, care, and referral needs of HIV-infected patients at appropriate levels of the health care system, according to national guidelines.
This indicator is a compendium of many different aspects of care and service provision, all of which must score a minimum amount if the indicator is to include the facility in its numerator. Because services tend to improve unevenly, especially in resource constrained settings, the resulting indicator may remain low for some time. Disaggregation of the indicator will indicate the areas in which services have improved and those in which they continue to lag.
The scoring of the components of the indicator will necessarily include a measure of subjectivity. This subjectivity may influence comparisons between different countries, as well as trends over time if the monitoring team changes.
Because it includes facilities at different levels of service provision, the indicator is not weighted by client load. Weighting by client load is likely to give tertiary institutions and reference hospitals excessive influence in the indicator, despite the fact that most patients first come into contact with the health system at the primary level.
health system strengthening (HSS), quality, HIV/AIDS, integration