Health System Barriers and Facilitators Influencing TB/HIV Integration in Ghana
Gloria Akosua Ansa *
Public Health Unit, University of Ghana Hospital, Legon, P.O.Box LG 79, Legon, Accra, Ghana.
John D. Walley
NCIHD, University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, United Kingdom.
Kamran Siddiqi
Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, United Kingdom.
Xiaolin Wei
School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China.
*Author to whom correspondence should be addressed.
Abstract
Introduction: A quarter of all TB cases in Ghana were HIV-positive at the end of 2012. The integration of TB and HIV services is anticipated to improve patient access to comprehensive care. Key health system components for successful integration are leadership and governance, health information systems, health financing, human resources for health, essential medical products and technologies, and service delivery This paper explores the health system barriers and facilitators influencing TB/HIV integration in Ghana.
Study design: An interpretivist qualitative approach was employed and semi-structured interviews were used to generate data.
Place and Duration: The study was conducted in the Eastern Region of Ghana between May and July 2009.
Methodology: Three urban district hospitals with three different service delivery models with increasing levels of integration were purposively selected as study sites. Semi-structured interviews were conducted with purposively sampled TB/HIV patients, providers and managers. The audio recorded interviews were transcribed and thematically analysed using a-priori and emergent codes.
Results: Twenty nine participants made up of 18 HIV-positive TB patients, eight providers and three managers participated in the study. Barriers included inadequate capacity, poorly motivated staff, different financial and health information systems, irregular and misapplied funds as well as differences in access to services. Facilitators included political will, direct supervision, regular supply of drugs, and privacy and confidentiality.
Conclusion: The impact of facilitators needs to be enhanced to address related barriers. Standardisation of norms and values, as well as new staff training methods should be used to achieve staff behavioural changes towards integration.
Keywords: Ghana, tuberculosis, TB/HIV, integration, health system, barriers, facilitators.