HIVcare integration attempt into a public hospital in Burundi

1
HIV-care integration attempt into a public
hospital in Burundi

• J. Cailhol, L. Munyana, T. Nahimana, H.
  Ntakarutimana,
• F. Musanabana, M. Dubreuil, D. Diack, C. Arvieux,
  
• O. Bouchaud, T. Niyongabo
• XVII International AIDS Conference, Mexico City
• August 6, 2008

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Burundi background

• Population approx. 8 million
• 1993-2005 civil conflict, UN still present
• Estimated 68 population living below poverty
  line
• HIV prevalence 6
• (UNAIDS 2006, WHO 2005)

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Burundi health sector

• Destruction/lack maintenance of health care
  infrastructure
• Total expenditure on health per capita 17
• Severe shortage of health care providers
• 0.03 physician and 0.19 nurse per 1000
  inhabitants
• difficult working conditions

Low quality health care High staff turnover
Loss of financial and time investments
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ESTHER program in Burundi

• Ensemble pour une Solidarité Thérapeutique
  Hospitalière en Réseau
• Partnership and network-building to empower
  public HIV-care sector, in collaboration with MOH
• Set up HIV-outpatient clinics
• integrated within 2 national-level public
  hospitals
• in the capital city Bujumbura
• Local staff recruited 3 physicians, 9 nurses

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Objectives and mechanisms of incentives

• Objectives to retain local health care staff
  and to improve quality of care
• Mechanisms financial, conditional
• to complement the base public salary
• maximal amount 200 of base salary
• regressive payment based on
• - regular attendance, punctuality
• regular participation to staff meetings

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From initial troubles.

• 2 level-salaries, poorly accepted
• significant consequences
• threats of strike
• bad will in HIV-clinic/hospital interactions
• stigmatization of Esther staff

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to better integration

• Sensitization campaign led by the director
• Educational trainings for all the hospital staff
• Financial incentive extended to replacement staff
  from hospital
• HIV-clinic benefits distributed to hospital
  administrative staff

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Two years efficiency evaluation

• Quantity of care HIV-cohort gt 3000 persons
• Quality of care patients satisfaction rate gt85
• Respect of the clocking system (95), overtime
• Brain-drain of original recruit 0 physician, 1
  nurse (retention rate 92)
• Staff dynamism

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Lessons learned

• Financial incentives allow improvement of
• overall quality of care and
• quality of life of health care professionals
• Needs for considering the health care
  professionals as a whole

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Next steps

• Assessment method
• Incentives mechanisms
• individual / collective, non financial /
  financial
• Evaluation of job satisfaction
• Salary harmonisation at national and
  international-level
• Expand implementation to the whole health sector
  and beyond
• Involvement of international financial
  institutions

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• PICTURE !!