Summary:

The feasibility and potential benefits of collaboration between the traditional and public healthcare sectors in Uganda and Zambia will be assessed. The focus will be on improving the humanity and public health dimensions of STI/HIV/AIDS care between both categories of providers. Collaborative models will be designed, based on studies of community and provider needs and preferences, and assessments of quality of care in both settings, using a prospective policy analysis approach. Qualitative and quantitative methods are used. Intervention, based on these data, will be implemented at district/municipal level, with joint training involving traditional and public providers. A before-and-after quasi-experimental evaluation will assess process and outcome indicators, providing evidence that collaborations can work and, at the same time, increase access to essential care services.

Objectives:

The objective is to develop and evaluate strategies that build understanding, and facilitate dialogue and collaboration between public and traditional healthcare providers in Uganda and Zambia. The aim is to improve the quality and increase the uptake of STI/HIV/AIDS healthcare services, focusing on the humanity of patient/provider interactions and the uptake of prevention and care services in both sectors. Specific objectives are to assess the community and provider views on existing services, theirs as well as policy-makers' attitudes towards collaboration; and the quality of care in both sectors. These data will be used to design an intervention, targeted at both categories of providers. The evaluation will provide evidence of the effectiveness of the collaboration, and of changes in numbers of patients accessing services. A policy analysis stream aims to facilitate getting research lessons into policy and practice.

Description:

Stakeholders at four levels will be involved: policy-makers, community members, traditional and public healthcare providers and patients. In the planning phase, reviews of earlier models of public-traditional collaborations and current national policies will be inputted into a planning workshop in Uganda. There, methodologies, general intervention components and data collection tools will be agreed upon, and key concepts and quality indicators will be put into operation. Country workshops will then adapt these outputs to their contexts and train field workers. Pre-intervention data collection will use stakeholder analysis tools to analyse the different stakeholders' (especially policy-makers and provider representatives) interests, power and resources; and the collaborative models that are broadly acceptable and supportable by them. Qualitative surveys will assess community members' and providers' perceptions of the quality of existing STI/HIV/AIDS care in both sectors, and attitudes of each towards intersectoral collaboration. Similarly, a range of methods - facility record reviews (to show current service uptake), patient exit interviews and observations of provider-patient interactions - will assess baseline quality of services. Indicators for measuring inter-sectoral collaboration and uptake of services will be, for example, patients receiving STI treatment and VCT, cross-referrals, and support and access to prevention and treatment services. Monitoring systems for these indicators will be established. Based on the above inputs, the intervention will utilise interactional group discussions and provider training, bringing together both types of providers - supported by peer (provider) influencing networks, to introduce and reinforce evidence-based quality promoting practices, which increase access to and provide better quality services. The before-and-after evaluation, with monitoring of secular effects in control communities, will provide evidence to feed into policy-making.

Milestones:

1) Analyse how people utilise traditional and public sector healthcare.

2) Identify health service user and provider needs, and preferences in configuring better care.

3) Evaluate the effects of implementing traditional-public sector collaborative care models, measuring process indicators of successful collaboration and outcome indicators of increased uptake of key STI/HIV/AIDS services.

4) Involve policy-makers from project inception to get research into action.

Coordinator:

Partners:

2. London School Of Hygiene and Tropical Medicine UK-London, United Kingdom
3. Traditional and Modern Health Practitioners Together Against Aids and Other Diseases
4. Theta Organisation Kampala, Uganda
5. University of Zambia - Institute of Economic and Social Research, Lusaka, Zambia
6. Traditional Health Practitioners Association of Zambia, Lusaka, Zambia
7. Makerere University - Institute Of Public Health Kampala, Uganda