Health system response to preventing mother-to-child transmission of HIV policy changes in Zambia: a health system dynamics analysis of primary health care facilities

Jonathan Mwanza; Mary Kawonga; Andrew Kumwenda; Glenda E Gray; Wilbroad Mutale; Tanya Doherty

doi:10.1080/16549716.2022.2126269

Health system response to preventing mother-to-child transmission of HIV policy changes in Zambia: a health system dynamics analysis of primary health care facilities

Glob Health Action. 2022 Dec 31;15(1):2126269. doi: 10.1080/16549716.2022.2126269.

Authors

Jonathan Mwanza¹, Mary Kawonga^{1

2}, Andrew Kumwenda³, Glenda E Gray⁴, Wilbroad Mutale⁵, Tanya Doherty^{1

6}

Affiliations

¹ School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
² Department of Community Health, Charlotte Maxeke Johannesburg Academic Hospital Johannesburg, Johannesburg, South Africa.
³ Department of Obstetrics and Gynaecology, School of Medicine, University of Zambia, Lusaka, Zambia.
⁴ Office of the President, South Africa Medical Research Council, Cape Town, South Africa.
⁵ School of Public Health, University of Zambia, Lusaka, Zambia.
⁶ Health Systems Research Unit, South Africa Medical Research Council, Cape Town, South Africa.

Abstract

Background: Zambia is focusing on attaining HIV epidemic control by 2021, including eliminating Mother to Child Transmission (eMTCT) of HIV. However, there is little evidence to understand frontline healthcare workers' experience with the policy changes and the readiness of different health system elements to contribute to this goal.

Objective: To understand frontline healthcare workers' experience of preventing mother-to-child transmission (PMTCT) of human immunodeficiency (HIV) policy changes and to explore the health system readiness to respond to rapid changes in PMTCT policy by using the health system dynamic framework.

Method: We conducted a qualitative study in which 35 frontline healthcare workers were selected and interviewed using a snowball sampling technique. All transcripts were analysed through thematic content analysis and deductive coding. Themes were derived and presented according to the health system dynamics framework.

Results: Among the ten elements of the health system dynamics framework, service delivery, context, and resources (i.e. infrastructure and supplies, knowledge and information, human resource, and finance) were critical in implementing the continuously evolving PMTCT policies. Furthermore, due to the fragmented primary health care platform in Zambia, non-governmental organisations (NGOs) were instrumental in ensuring that the PMTCT programme met the demand and requirements of the general population. Frontline healthcare workers who participated in the study described inequity in access to ART services due to the service delivery model employed in the selected study sites.

Conclusion: The study highlights challenges when policies are implemented without consideration for the readiness, context, and capacity in which the policy is implemented. We offer lessons that can inform implementation of universal health coverage of antiretroviral therapy (ART), a strategy many countries have adopted, despite weak health systems.

Keywords: ART; Health system; eMTCT; prevention of mother-to-child transmission of HIV (PMTCT); primary health care; zambia.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Female
HIV Infections* / drug therapy
HIV Infections* / prevention & control
Humans
Infectious Disease Transmission, Vertical / prevention & control
Policy
Pregnancy
Pregnancy Complications, Infectious*
Primary Health Care
Systems Analysis
Zambia / epidemiology

Grants and funding

The study was funded by the UNC-UNZA-Wits Partnership for HIV and the Women’s Reproductive Health (UUW) Ph.D. training programme.