Health facilities with the capacity to deliver appropriate care to HIV-infected patients

Export Indicator

The percent of health care facilities at different levels of the health care system that have the capacity to deliver appropriate palliative care, treatment for opportunistic infections and referral for HIV-infected patients, according to national guideli
What it measures

This indicator measures the extent to which health services have the capacity to meet  treatment, care and referral needs of HIVinfected patients at appropriate levels of the health care system, according to national guidelines.

Rationale

In the early years of the HIV epidemic, a high proportion of patients with HIV-associated conditions were automatically referred to tertiary level institutions because health services at other levels had neither the trained personnel nor the capacity to cope with them appropriately. Even guidelines on what constituted “appropriate” treatment were rarely available. The constant referral to higher levels of care clearly led to inefficient use of resources within the health system. In recent years, attempts have been made to ensure that HIV-related conditions are dealt with at appropriate levels within the health system, with referrals in both directions when necessary. Many countries have produced national guidelines to help guide service providers in the appropriate care of HIV-infected patients. Palliative care and treatment for common and minor opportunistic infections may be given at the primary level, while more complex opportunistic infections may be referred to higher levels of the health care system. Referrals should also be made for social and psychological support where appropriate.

Numerator

Number of health facilities matching or exceeding the minimum score for adequate capacity to manage HIV-infected patients

Denominator

Total number of health facilities surveyed

Calculation
Method of measurement

In a health facility survey that includes facility inspection, interviews with service providers and records reviews, health facilities are assessed against a standard checklist. The checklist, which will be modified according to local standards, will differ according to the level of the institution within the health care system. It will typically include the availability of trained staff, the adequacy of diagnostic facilities, the adequacy of sanitation, the adequacy of nursing care, procedures for record keeping, preventative counselling, and referral to higher level care and community support organisations as appropriate. The assessment of “adequate” or “appropriate” conditions and services should follow national guidelines for care of HIV-infected patients. The absence of such guidelines is in itself an indication that care and support services for HIV-infected people are likely to be inadequate. However, where they do not exist, international standards currently being developed by WHO may be substituted in determining standards against which facilities are to be measured. The availability of drugs and procedures to prevent accidental transmission of HIV within the health care setting are covered by separate indicators and are not included here. The indicator is the number of health facilities matching or exceeding the minimum score for adequate capacity to manage HIV-infected patients, divided by the total number of health facilities surveyed. For programme purposes it should be disaggregated by level of health facility as well as by area of service provision.

Measurement frequency
Disaggregation

Education: N/A

Gender: N/A

Geographic location: N/A

Pregnancy status: N/A

Sector: N/A

Target: N/A

Time period: N/A

Type of orphan: N/A

Vulnerability status: N/A

Explanation of the numerator
Explanation of the denominator
Strengths and weaknesses

This indicator is a compendium of many different aspects of care and service provision, all of which must score a minimum amount if the  facility is to be included in the numerator of the indicator. Because services tend to improve unevenly, especially in resource constrained settings, the resulting indicator may remain low for some time. Disaggregation of the indicator will indicate the areas in which services have improved and those in which they continue to lag. The scoring of the components of the indicator will necessarily include a measure of subjectivity. This may influence comparisons between different countries, as well as trends over time if the monitoring team changes. The indicator is not weighted by client load. This is because it includes facilities at different levels of service provision. Weighting by client load is likely to give tertiary institutions and reference hospitals excessive influence in the indicator, despite the fact that most patients first come into contact with the health system at the primary level. This indicator is similar, but not identical, to the WHO’s Care and Support Indicator 1 (CSI1). Since CSI1 has not yet been widely used, this is unlikely to affect trends over time in many countries.

Further information