Overview

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Early 2007 a pilot study was completed, commissioned as part of the Whole Systems Assessment and Response ( WSAR) project of the UK Department for International Development ( DFID), "Knowledge for Action in HIV/AIDS and STIs Programme". Given the fragmented nature of current HIV/AIDS treatment programmes in Africa, the WSAR project's purpose is to promote a holistic approach to the assessment and control of HIV/AIDS epidemics. It uses a model that links situational assessments to response planning, and explores the interacting effects of interventions with their wider environmental contexts.

HEARD in collaboration with researchers from the University of East London (UK), undertook this experimental project, which involved a series of mixed-method, rapid assessment studies of selected HIV/AIDS intervention programmes and health systems in Ghana and South Africa. The study assessed how the scale-up of anti-retroviral treatment (ART) programmes affects health workers from the perspective of work motivation, with a view to suggesting practical strategies for improving work conditions.

The focus of the study in South Africa was on public ART programmes, specifically on three key areas: health financing and expenditure, service provision and utilisation, and human resources. A self-reported questionnaire on working conditions was administered to a randomly selected sample of nurses and doctors including individuals who work with HIV-positive patients and those who do not, at hospitals and clinics within the Ilembe District in KwaZulu-Natal and Winelands Region in the Western Cape. Selected quantitative research tools were used to compare differences.

The conclusion was that the expansion of South Africa's public health ART delivery programme has influenced staff motivation in particular ways. For example: contrary to expectations, the study showed that the work environment of ART personnel was comparatively favourable, with higher job satisfaction, lighter workloads, better staffing levels and lower sickness absence than claimed by non-ART personnel. However, ART workers are likely to become over-burdened if, with further scale-up of treatment services, recruitment and retention of staff do not match the increased demands placed on these facilities.
Some issues for further investigation that emerged from the analysis included:

Expansion of the ART programme appears to have improved public use of VCT facilities, but has not improved participation in or the outcomes of the PMTCT programme.

Improvement in the use of VCT facilities does not seem to be driven by public demand, but rather by the renewed interest of doctors and nurses in diagnosis, now that they can follow up clinical assessments with appropriate treatment regimens.


The roll-out of ART in both the Ilembe district and the Cape Winelands region has been positive; however, certain obstacles should be addressed urgently to optimise these programmes for access to the facilities and adequate care. An illustrative comment emerged from an interview held in the district:

"This district has 600 000 people. I mean as a general sort of just bench-mark figure, about a third of them are definitely [HIV-]positive. That's 200 000 people and the WHO estimates that 10% of that would actually require ARV right now. That's 20 000 people. So I'd say we are addressing 10% of the need in this area."

Project updates

To download WSAR's most recent published article please click here.