The uncertain future of lay counsellors
Continuation of HIV services in Lesotho under pressure
Bibliographic Data
| ID | 11490408 |
|---|---|
| Authors | Marielle Bemelmans (Médecins Sans Frontières, corresponding author), Delphine Goux (Médecins Sans Frontières), Saar Baert (0000-0002-9822-148X, Médecins Sans Frontières), Gilles van Cutsem (0000-0002-8972-4480, Médecins Sans Frontières), Mabaruti Motsamai (Médecins Sans Frontières), Mit Philips (0000-0002-3211-768X, Médecins Sans Frontières), Willemien Van Damme (0000-0002-6344-3007, Instituut voor Tropische Geneeskunde), Wim Van Damme, Hilary Mwale (President's Emergency Plan for AIDS Relief), Marc Biot (Médecins Sans Frontières), Thomas van den Akker (0000-0002-9890-9145, Leiden University Medical Center) |
| Year | 2016 |
| Volume | 31 |
| Issue | 5 |
| Pages | 592-599 |
| Publication date | 2016-06-01 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Health Policy and Planning (JOURNAL) |
| Journal identifiers | ISSN: 0268-1080 • E-ISSN: 1460-2237 |
| Publisher | Oxford University Press (PUBLISHER • GB) |
| DOI | 10.1093/heapol/czv106 |
| PMID | 26546581 |
| OpenAlex | W2097547005 |
| Language | EN |
| References cited | 13 |
Between 2006 and 2011, when antiretroviral therapy (ART) was scaled up in a context of severe human resources shortages, transferring responsibility for elements in human immunodeficiency virus (HIV) care from conventional health workers to lay counsellors (LCs) contributed to increased uptake of HIV services in Lesotho. HIV tests rose from 79 394 in 2006 to 274 240 in 2011 and, in that same period, the number of people on ART increased from 17 352 to 83 624. However, since 2012, the jobs of LCs have been at risk because of financial and organizational challenges. We studied the role of LCs in HIV care in Lesotho between 2006 and 2013, and discuss potential consequences of losing this cadre. Methods included a case study of LCs in Lesotho based on: (1) review of LC-related health policy and planning documents, (2) HIV programme review and (3) workload analysis of LCs. LCs are trained to provide HIV testing and counselling (HTC) and ART adherence support. Funded by international donors, 487 LCs were deployed between 2006 and 2011. However, in 2012, the number of LCs decreased to 165 due to a decreasing donor funds, while administrative and fiscal barriers hampered absorption of LCs into the public health system. That same year, ART coverage decreased from 61% to 51% and facility-based HTC decreased by 15%, from 253 994 in 2011 to 215 042 tests in 2012. The workload analysis indicated that LCs work averagely 77 h per month, bringing considerable relief to the scarce professional health workforce. HIV statistics in Lesotho worsened dramatically in the recent era of reduced support to LCs. This suggests that in order to ensure access to HIV care in an under-resourced setting like Lesotho, a recognized and well-supported counsellor cadre is essential. The continued presence of LCs requires improved prioritization, with national and international support.
Antiretroviral therapy · Context (archaeology) · Economic shortage · Family medicine · Geography · Government (linguistics) · Health care · Human immunodeficiency virus (HIV) · Management · Political science · Public health · Viral load · Workforce · Workload · Adolescent Sexual and Reproductive Health · HIV/AIDS Impact and Responses · HIV/AIDS Research and Interventions · Medicine · Nursing
| Highly cited | No |
|---|