'I believe that the staff have reduced their closeness to patients': An exploratory study on the impact of HIV/AIDS on staff in four rural hospitals in Uganda
BMC Health Services Research
KIT Development Policy and Practice, Royal Tropical Institute, Amsterdam, Netherlands; Faculty of Health Sciences, Uganda Martyrs University, Nkozi, Uganda; KIT Biomedical Research, Royal Tropical Institute, Amsterdam, Netherlands; Health Partners Uganda Health Cooperation, Kampala, Uganda; Radboud University Medical Centre, Nijmegen, Netherlands
Background. Staff shortages could harm the provision and quality of health care in Uganda, so staff retention and motivation are crucial. Understanding the impact of HIV/AIDS on staff contributes to designing appropriate retention and motivation strategies. This research aimed 'to identify the influence of HIV/AIDS on staff working in general hospitals at district level in rural areas and to explore support required and offered to deal with HIV/AIDS in the workplace'. Its results were to inform strategies to mitigate the impact of HIV/AIDS on hospital staff. Methods. A cross-sectional study with qualitative and quantitative components was implemented during two weeks in September 2005. Data were collected in two government and two faith-based private not-for-profit hospitals purposively selected in rural districts in Uganda's Central Region. Researchers interviewed 237 people using a structured questionnaire and held four focus group discussions and 44 in-depth interviews. Results. HIV/AIDS places both physical and, to some extent, emotional demands on health workers. Eighty-six per cent of respondents reported an increased workload, with 48 per cent regularly working overtime, while 83 per cent feared infection at work, and 36 per cent reported suffering an injury in the previous year. HIV-positive staff remained in hiding, and most staff did not want to get tested as they feared stigmatization. Organizational responses were implemented haphazardly and were limited to providing protective materials and the HIV/AIDS-related services offered to patients. Although most staff felt motivated to work, not being motivated was associated with a lack of daily supervision, a lack of awareness on the availability of HIV/AIDS counselling, using antiretrovirals and working overtime. The specific hospital context influenced staff perceptions and experiences. Conclusion. HIV/AIDS is a crucially important contextual factor, impacting on working conditions in various ways. Therefore, organizational responses should be integrated into responses to other problematic working conditions and adapted to the local context. Opportunities already exist, such as better use of supervision, educational sessions and staff meetings. However, exchanges on interventions to improve staff motivation and address HIV/AIDS in the health sector are urgently required, including information on results and details of the context and implementation process. © 2007 Dieleman et al; licensee BioMed Central Ltd.
antiretrovirus agent; acquired immune deficiency syndrome; adult; article; controlled study; counseling; cross-sectional study; exploratory research; female; general hospital; health care personnel; health service; hospital personnel; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; human relation; infection; interview; major clinical study; male; medical staff; qualitative analysis; quantitative analysis; rural area; structured questionnaire; Uganda; workload; workplace; administrative personnel; epidemiology; fear; health personnel attitude; hospital; job satisfaction; motivation; organization and management; psychological aspect; questionnaire; social psychology; Administrative Personnel; Attitude of Health Personnel; Cross-Sectional Studies; Fear; Health Care Surveys; HIV Infections; Hospitals, Rural; Humans; Job Satisfaction; Motivation; Professional-Patient Relations; Questionnaires; Stereotyping; Uganda; Workload; Workplace