Factors influencing decentralization of Antiretroviral treatment services in the health sector: the case of Nyeri County, Kenya

Abstract

The purpose of the study was to establish the factors influencing decentralization of antiretroviral treatment (ART) services in Nyeri County. Using a descriptive survey design, the study targeted Nyeri County health providers dealing with care and treatment of HIV patients in health facilities (Service Delivery Points) and the District Health Management Teams (DHMT) responsible for implementation of ART decentralization policies in Nyeri County. Employing purposive and stratified sampling, the researcher sampled 61 respondents to represent the DHMT, ART sites as well as Non-ART sites. Data was collected using a structured questionnaire and analysed using SPSS version 20 for windows.

Research revealed that policies were moderately effective while an equal number said they were less effective. The major challenge in implementing these policies was inadequate funds and shortage of staff in the health facilities. The quality of health was found to be high with facilities having a patient retention of above 90% and patients were appropriately referred to other facilities where they would access the services lacking services in their attached facility.

The infrastructural capacity was also found to be inadequate. Only 53.3% of the facilities had adequate storage area to accommodate ART commodities while 33.3% said they did not have adequate patient consultation rooms. Majority said the infrastructure was inadequate and impacted negatively on ART decentralization. Generally the financial capability was inadequate, and majority of the sites said financial support was fair. The researcher concluded that despite the decentralization policies being found to be less effective and inadequate they did not affect the quality of services.

The researcher recommended that the District Health Management Team should open more ART sites and convert standalone sites to central sites to ease the pressure on the available central sites and the government should source for more resources and employ more staff to facilitate the decentralization of ART services through increased collaborative activities with other stakeholders in the region.