Number/percent of health facilities with the capacity to deliver appropriate care to HIV-infected patients

Number/percent of health facilities with the capacity to deliver appropriate care to HIV-infected patients

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

Data Requirement(s):

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

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