Health Care Workers Sarah L Mwilima, MSc Rachel A. Smith, PhD

Service Delivery: Expected Outcomes Improve quality of service delivery and care at six government hospitals Increase provider interpersonal communication and counseling skills Improve client-provider relations Improve quality of care to clients Current perceptions?

Health care workers Combined Findings: Network (161) & Household (80) datasets Mean SD MAX MIN Age 36 9.5 71 19 Education 10 3.3 19 0

Health care workers Oshivambo Thimbukushu Rugiriku Kwangali Afrikaans Oniipa (42) Oshikuku (45) Oshakati (19) Andara (14) Nyangana (33) Rundu (28) Thimbukushu Rugiriku Kwangali Afrikaans Katutura (11) Rehoboth (17) Windhoek (6) Walvis Bay (20) Health care workers Afrikaans Keetmanshoop (6) Afrikaans Damara Nama

Current perceptions HIV test clinics give accurate results, Provide quality services, Give good care; Health care workers care about me.

Additional Perceptions Agree that health care workers are rude to clients 48% Community members 56% Health care workers Believe that sometimes health care workers tell others their private health information 46% Community members 46% Health care workers

Baseline Establish base of knowledge, attitudes, and practices in communities regarding Prevention: sexual transmission, mother-to-child VCT ART and OVC programs

Transmission Knowledge Next slide, network: MTCT knowledge

Health workers (32): Oshikuku MTCT knowledge EVANGELICAL LUTHERAN CHURCH = 1 method or no methods = 2 methods = all 3 methods

Health workers (13): Oshakati MTCT knowledge = men = women = 1 method or no methods = 2 methods = all 3 methods

Networks: Diffusion Health care workers who participate in social groups may Diffuse information (accurate or inaccurate) and attitudes into the community

Health workers (32): Nyangana MTCT knowledge = 1 method or no methods = 2 methods = all 3 methods

Group centrality (Leaders): Nyangana = 1 method or no methods = 2 methods = all 3 methods BAPTIST CHURCH LUTHERAN CHURCH

Knowledge of Transmission Prevention

Group centrality (Leaders): Nyangana = no HIV testing/ 1 partner = HIV testing/ 1 partner = no testing/ multiple partners = HIV test/ multiple partners

Capacity Building: Print Materials Sample Topics: VCT PMTCT Treatment and care Consistency in current information?

What should a person do once they find out that they have HIV?

Print materials Consistent information Provide guidance for Family Members Inoculate against stigma Include those living with HIV in the development

Secrets & Suspicion If family member contracted HIV, would you want to keep it a secret? 40% Community Members 39% Health Care Workers Highest in Oshikuku, Oshakati, Nyangana, & Andara Health care workers, do you know a child with HIV? Yes, 46% How did you find out? Child’s Mother died 62%

Witchcraft & HIV/ AIDS Highest in Windhoek, Katutura, Rundu

Supportive resources Expressions of encouragement, hope, reassurance, caring, concern Feedback about health behavior & health risks General health information Modeling health behavior Facilitating coping Knowledge of services available for those living with HIV and their dependents?

Services Available for Those Living with HIV

Services for OVCs

Do you think that AIDS can be solved in Namibia?

Program Suggestions Increase knowledge about HIV transmission and prevention Provide consistent information Address stigma and witchcraft Repeat information in media programs Provide information and training for formal and informal discussions Train family members on giving advice and support

Continuation… On the Service delivery side More information to health workers on ART PMTCT and VCT through print and Media Training of health workers on interpersonal communication on ART, PMTCT and VCT Interventions should be both supportive and persuasive Interventions promoting psychosocial support of Health Workers to deal with their own fears and experiences of HIV and AIDS.

Making a difference in people’s lives . . . Thank YOU Questions? Making a difference in people’s lives . . .