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HIV/AIDS Service Provision Assessment

With an HIV/AIDS prevalence rate estimated at 4.7 percent, Côte d’Ivoire is one of the countries in West Africa most affected by the HIV/AIDS epidemic. For more than a decade, the government of Côte d’Ivoire has worked to develop the health system to meet the needs of its population, placing particular emphasis on the fight against the three major transmissible diseases: HIV/AIDS, tuberculosis, and malaria. To better target its efforts against these diseases, the Ministry of Health and Public Hygiene (MOH), in collaboration with Health Systems 20/20 and PEPFAR, conducted a service provision assessment (SPA) to evaluate HIV/AIDS-related service provision in the public and private health sectors.

The SPA surveyed 300 health facilities, providing a nationally representative sample of government, non-governmental (including faith-based), and privately managed facilities providing HIV/AIDS services. Read the full report.

Findings

Several general findings regarding HIV/AIDS service availability emerge from the SPA:

• First, key services investigated, including counseling and testing (CT), laboratory, TB, prevention of mother-to-child transmission (PMTCT), and antiretroviral therapy (ART), are available in only 25 percent or fewer of health facilities. Most of the facilities that do provide these services are in the public sector.
• Second, the majority of health facilities and HIV/AIDS service providers are concentrated in the southern part of the country, where there is greater population density. Conversely, HIV/AIDS service availability is sparse in the northern regions.
• Other findings suggest that only four percent of all facilities offer ART, and of those facilities, hospitals and health centers are the primary providers; PMTCT service availability is limited to seven percent of facilities and concentrated at the secondary and tertiary levels of care; the majority of facilities (68 percent) either offer HIV testing or refer patients to HIV testing services; only 25 percent of facilities offer counseling as well as testing; and care and support services for HIV patients is provided by only 13 percent of facilities.

Recommendations

Recommendations based on the findings of the assessment include:

• Expanding the provision of PMTCT and ART strategically to facilities located in high prevalence areas and to lower-level facilities that can partner with a hospital or health center already providing ART for quality assurance;
• Decentralizing PMTCT services to clinics and dispensaries to increase accessibility in rural areas;
• Integrating ARV and TB treatment to improve both services’ availability and case management of co-morbidity, and;
• Increasing the counseling component of CT and monitoring to verify that counseling emphasizes prevention; and coordinating with the private sector to provide a broader range of services.