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A qualitative exploration of the human resource policy implications of voluntary counselling and testing scale-up in Kenya: applying a model for policy analysis

Taegtmeyer, Miriam ORCID:, Martineau, Tim ORCID:, Namwebya, J, Ikahu, A, Ngare, C, Sakwa, J, Lalloo, David ORCID: and Theobald, Sally ORCID: (2011) 'A qualitative exploration of the human resource policy implications of voluntary counselling and testing scale-up in Kenya: applying a model for policy analysis'. BMC Public Health, Vol 11, :812.

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Background: Kenya experienced rapid scale up of HIV testing and counselling services in government health
services from 2001. We set out to examine the human resource policy implications of scaling up HIV testing and
counselling in Kenya and to analyse the resultant policy against a recognised theoretical framework of health
policy reform (policy analysis triangle).

Methods: Qualitative methods were used to gain in-depth insights from policy makers who shaped scale up. This
included 22 in-depth interviews with Voluntary Counselling and Testing (VCT) task force members, critical analysis
of 53 sets of minutes and diary notes. We explore points of consensus and conflict amongst policymakers in Kenya
and analyse this content to assess who favoured and resisted new policies, how scale up was achieved and the
importance of the local context in which scale up occurred.

Results: The scale up of VCT in Kenya had a number of human resource policy implications resulting from the
introduction of lay counsellors and their authorisation to conduct rapid HIV testing using newly introduced rapid
testing technologies. Our findings indicate that three key groups of actors were critical: laboratory professionals,
counselling associations and the Ministry of Health. Strategic alliances between donors, NGOs and these three key
groups underpinned the process. The process of reaching consensus required compromise and time commitment
but was critical to a unified nationwide approach. Policies around quality assurance were integral in ensuring
standardisation of content and approach.

Conclusion: The introduction and scale up of new health service initiatives such as HIV voluntary counselling and
testing necessitates changes to existing health systems and modification of entrenched interests around
professional counselling and laboratory testing. Our methodological approach enabled exploration of complexities
of scale up of HIV testing and counselling in Kenya. We argue that a better understanding of the diverse actors,
the context and the process, is required to mitigate risks and maximise impact.

Item Type: Article
Uncontrolled Keywords: human resource, voluntary counselling, qualitative
Subjects: QY Clinical Pathology > Diagnostic Tests > QY 250 Immunodiagnostic tests
WA Public Health > Health Administration and Organization > WA 525 General works
WC Communicable Diseases > Sexually Transmitted Diseases > WC 142 Public health control measures
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
Faculty: Department: Groups (2002 - 2012) > Clinical Group
Groups (2002 - 2012) > International Health Group
Digital Object Identifer (DOI):
Depositing User: Faye Moody
Date Deposited: 24 Jan 2012 11:18
Last Modified: 17 Oct 2019 10:51


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