Do Nurses Know the TB and HIV/AIDS Policies They are Expected to Implement? A Case of Health Facilities in a Rural Sub-District of the Western Cape

Tuberculosis and HIV/AIDS epidemic has been on the international agenda for more than three decades. Though some achievements have been marked, sub-Sahara Africa is still grappling with moving towards the Millennium development goals. South Africa is one of Sub-Sahara African countries reported to have a high burden of both these diseases. Increase in political commitment has seen changes been made in the health system resulting in some achievements. However a lot still need to be done as the prevalence rates of both these diseases are still high especially in the rural areas. 

Implementation of TB and HIV/AIDS policies has been highlighted as one of the challenges in the health system. It has been noted in the policy analysis and implementation fields that for successful policy implementation to happen, all the actors in the health system need to be involved. In the South African context nurses are the largest cadre of health workers and have been described as the first line of contact with patients in health facilities especially in the rural areas thereby major actors in the policy implementation process. Therefore nurses plays a pivotal role in the implementation of TB and HIV/AIDS policies hence their knowledge of policies, how they implement the policies and the barriers that influence implementation in their context need to be analysed so as to develop intervention strategies that could improve policy implementation. The objective of this presentation is to describe the knowledge of the nurses with regarding to the policies they are expected to implement in the TB and HIV/AIDS programs in South Africa. This presentation is part of a bigger study done to analyse the implementation of TB and HIV policies in the health facilities of a rural sub-district in the Western Cape so as to develop interventions for improvement.  Walt and Gilson’s model of health policy analysis which focuses on the actors’ knowledge, practice and context was used as a theoretical framework to guide the research question, the design and intervention development process.

Mixed method approach with concurrent transformative design was followed wherein the data was given equal priority. The knowledge measure focused on policy components related to patient diagnosis, testing, prevention of the spread of diseases and initiation treatment as defined in TB and HIV/AIDS national and/or provincial guidelines. The target population of this study comprised of all categories of nurses (Enrolled nursing assistants, Enrolled nurses and Registered nurses) working in the health facilities in the selected sub-district (n ~ 87). However the accessible population was drawn from four clinics and one day hospital (n~60) out of the eight available facilities.  This decision was based on the size of the clinic in terms of patients’ head count and activities undertaken in the clinic in relation to the study focus. Non-probability purposive sampling was used because the accessible population in this setting was small and well defined thus all legible participants were recruited. The inclusion criterion was that the participant should have been working in the sub-district for at least three months at the time of data collection. In the quantitative phase, a self-administrative questionnaire was used as a data collection tool and semi structured interviews were conducted in the qualitative phase. Data was analysed using SPSS statistical package and thematic coding for quantitative and qualitative data respectively.

The results showed that nurses were at different levels regarding the level of knowledge they have based on aspects like training and exposure to the policies. Managerial support was also reported as an enhancer to acquisition of knowledge while work load was seen as an impediment. It was also noted that although training opportunities were available, they were not used optimally. The study was also able to highlight what knowledge the nurses specifically rated higher in when assessed on the different spectrum of the policies activities which has a possible impact on patient care. The study concluded that increase in nurses’ knowledge regarding the importance of the policies and implications of improper practices due to lack of awareness need to be increased if successful policy implementation and better patients outcomes is to be achieved.