Does differentiated service delivery for HIV treatment change healthcare providers workload? Provider views from Malawi, South Africa and Zambia


BACKGROUND: Differentiated service delivery (DSD) models aim to make delivery of HIV treatment more efficient, reduce the burden on healthcare providers, decongest clinics, and improve quality of care and/or increase clinic capacity. Although many countries are implementing DSD models, there is limited evidence on how they affect providers' workloads.
METHODS: We surveyed providers (April-November 2021) at 43 public facilities in Malawi (12), South Africa (19), and Zambia (12). A convenience sample of 'ยค10 clinical (doctors, nurses etc.) and non-clinical (lay counsellors, data capturer etc.) providers per facility who had direct or indirect involvement in DSD implementation were invited to participate. Quantitative and qualitative questions examined changes in providers' work schedules and workloads associated with the advent of DSD models.
RESULTS: 444 providers were interviewed (n=142 Malawi, n=182 South Africa, n=120 Zambia). Most providers reported that DSD models freed up their time (74% Malawi, 71% South Africa, 93% Zambia) and made their jobs easier (90% Malawi, 73% South Africa, 98% Zambia). Freed-up time may have stemmed from seeing fewer patients/day (75% Malawi, 73% South Africa, 98% Zambia), and most respondents stated that DSD models led to changes in how their clinic was managed (80% Malawi, 67% South Africa, 90% Zambia). This change in management may have manifested in multiple ways: about a third reported spending more time with each patient, 11% reported working shorter hours; 11% said that DSD models led to more time for administrative duties. Qualitatively, providers described fewer patients seen daily due to DSD models, reducing their workloads and allowing more time for each patient for administrative tasks and for personal affairs due to shorter hours, resulting in lower stress overall.

CONCLUSIONS: A diverse sample of southern African providers reported that DSD introduction freed up time, made their jobs easier, and led to changes in patient and clinic management.

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