The effect of health facility renovation on HIV counselling and testing (HCT) service utilisation in health facilities in the Otjozondjupa region, Namibia
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AbstractThe Ministry of Health and Social Services in Namibia has embarked on a fight against the human immunodeficiency virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) pandemic. The human immunodeficiency virus counselling and testing (HCT) services comprises the core component of the prevention, treatment and care pertaining to HIV. The purpose of this study was to investigate the effect of the renovation of health facilities on the HCT service utilisation. The study used a quantitative, quasi-experimental research design to determine the effect of health facilities’ renovations on the utilisation of the HCT service. The study population included health facilities that have been renovated, as well as health facilities that have not been renovated, but which met the inclusion criteria. The study sample comprised eight public health facilities that had offered HCT services between 2005 and 2011. Of the eight public health facilities 25% were hospitals, 25% were primary health care centres and 50% were primary health care clinics. Permission was obtained from the ethical review committees of the University of Namibia and the Ministry of Health and Social Services to conduct a pilot study and the actual research study as well as the confidentiality of the clinical records was assurred. The study concluded that there was no significant effect of the renovations to health facilities on HCT service utilisation. However, the study also revealed that 50% of the health facilities that formed the study sample had not been renovated. The study also found that 50% of the health facilities included an adolescents friendly health services (AFHS) room while the remainder did not have such rooms. As part of the study’s confounding factors it was found that the catchment population of the health facilities had increased by a margin of 1.4 from before the renovations to after the renovations. Furthermore, with regard to the distances from one health facility to the next, 37.5 % of the health facilities were found to be situated in excess of 91 kilometres away from the closest health facility. Although the study did not show significant evidence of an effect of the renovations to health facilities on the HCT service utilization, from a systems point of view, the study recommends an increased investment of resources in studies to determine the factors that affect HCT service utilisation, minor capital budget decentralisation, more maintenance and repair to health facilities, the inclusion of AFHS rooms, reduction in distances between health facilities, the use of various HCT models, the integration of HCT into primary health care outreach services and a large-scale study on other factors that affect HCT utilisation with the focus on the dynamics of the catchment population.
A thesis submitted in partial fulfillment of the requirement for the Degree of Master in Public Health