Challenges of Health Workers in Providing Counselling Services to HIV-positive Children in Uganda - Term Paper Example

?The article, Challenges Faced by Health Workers in Providing Counselling Services to HIV-positive Children in Uganda: A Descriptive Study, written by Joseph Rujumba, Cissy L. Mbasaalaki-Mwaka and Grace Ndeezi (2010) and published in Journal of the International Aids Society, is focused on the counselling and testing services available to children in Ugnada as well as the challenges faced by health workers in providing them. The study was centered in Kampala and Kabarole districts of Uganda, adopted both the qualitative and quantitative methodologies, and was formulated as a descriptive study. The study has been carried out in the context of many issue arising with respect to providing these services. Semi-structured individual interviews and focus group discussions were used as the data collection tools. Health workers providing care for HIV-positive children were the respondents of this study. There were also key informant interviews done with administrators of ten health care institutions selected for this study. Frequency tables were used to tabulate quantitative data while “qualitative data were analyzed using the content thematic approach” (Rujumba, Mbasaalaki-Mwaka and Ndeezi, 2010, p.1). The inferences of this study suggested that counselling HIV-positive children was reportedly a difficult task for the health workers (Rujumba, Mbasaalaki-Mwaka and Ndeezi, 2010, p.1). Several factors were reported to be causing this difficulty (Rujumba, Mbasaalaki-Mwaka and Ndeezi, 2010, p.1). The study concluded that knowledge gap, lack of counselling skills and limitations of the health system contributed to such issues (Rujumba, Mbasaalaki-Mwaka and Ndeezi, 2010, p.1). The study has also pointed out the specific areas where improvements and corrections could be made in this regard (Rujumba, Mbasaalaki-Mwaka and Ndeezi, 2010, p.1). The introductory section of this study has depicted the grave situation of the prevalance of HIV among children in Uganda using appropriate data and figures. Using authentic data, the gap in care provided to the HIV-positive children of Ugnada has been well-established. The need to focus more attention on HIV-infested children than adults is also delineated in the introductory section of the paper. How the parents are ill-equipped to cope with the care needs of HIV-positive children and how they are socially and economically not able to provide ample care is established with the support of previous studies. The introduction is thus to the point and empirically sound. By choosing the health care workers as the target group of respondents, this study has looked into the issue from their side alone. Health institution heads are also added to this segment of respondents as additional information providers. This study thus becomes more or less a system-centered research while the real beneficiaries of the system including the HIV-positive children and their parents are opted out. This is a limitation of this study. By using qualitative as well as quantitative methods in combination, this paper enhances the validity of its results. The triangulation of different sets of data gathered using three different tools strengthen the inferences. By selecting ten health care institutions, including all the public and faith-based hospitals in the area and two non-governmental organizations that were providing AIDS services under the purview of the study and also by keeping comparatively a larger size and diversity of the sample involved, the study has produced a set of data that is highly authentic and generalizable. Given the descriptive nature of this study, the purposive sampling adopted is well-suited. The study showed that only four of the ten health care institutions selected were having “full-fledged HIV counselling, testing and care services for children”, which is a crucial revelation (Rujumba, Mbasaalaki-Mwaka and Ndeezi, 2010, p.3). This inference points to the drastic situation at ground. Given the prevalence of AIDS in Uganda and the socio-economic backwardness of the population involved, the lack of facilities in the nearby health care institution can be fatal. Also the finding that 63.3% of the respondent health care professionals had any “formal training in counselling” shows how further aggravated the situation is. This is a major finding that can have future repercussions. It can prompt the authorities concerned into positive action regarding training of health care professionals to address the specific care needs of HIV-positive children. The study has also provided important information on which areas to concentrate while planning for a full-fledged HIV-positive child counselling and testing system. For it has to be capable of addressing the child-related, caretaker-related, health worker-related and system-related challenges as the study pointed out (Rujumba, Mbasaalaki-Mwaka and Ndeezi, 2010, p.4). The paper has elaborately discussed each of these challenges based on data gathered on each of these aspects. The child related issues include, the inability of children to express themselves fully, their dependent nature, the need of time and patience while counselling children, the children mostly being “needy” and “orphans”, the constant support needed for a child to stick to continuous counselling help, and the fears and helplessness that children feel in such situations (Rujumba, Mbasaalaki-Mwaka and Ndeezi, 2010, p.4). Similarly, the care-taker related issues have been listed as lack of ample knowledge to address the task involved, “lack of specialized skills”, the difficulties involved when the caretaker is a non-parent, difficulty in coping with the pain and fears of children especially when drawing blood from them for conducting tests, the ambiguity about how much information to disclose with a child, and the occasional refusal of the caretaker to carry out supplementary tests for further monitoring (Rujumba, Mbasaalaki-Mwaka and Ndeezi, 2010, p.4). The caretaker-related challenges are, when caretaker refuses to tell what exactly is the condition of the child and to get the child tested, and also when the caretaker does not have the proper health condition to care for the child and when they consider the HIV-positive child as a “burden” (Rujumba, Mbasaalaki-Mwaka and Ndeezi, 2010, p.5). Finally the institutional challenges identified by this study include, lack of appropriate ARV facility, a health care environment that is not adequately “child-friendly”, and absence of “referral networks” to provide more advanced care (Rujumba, Mbasaalaki-Mwaka and Ndeezi, 2010, p.6). All these lists are prepared in the descending order so that the first entry on the list is reported as the most recurring issue in the area concerned. There are also many other context-specific and not so frequent issues that the study has randomly picked up from the responses and added to the discussion though they have not been included in the empirical tabulations. When it comes to identifying the causes, and various aspects of the issue, this paper is almost exhaustive. In the discussion part of the study, these issues have been linked up with the overall HIV care situation in Uganda and the policies involved. The lack of adequate number health care workers and especially those who are skilled in the area, has been pointed out. The need for a general policy and guidelines is also stressed. The paper has discussed each and every aspect of the issue in its medical as well as socio-political and emotional context. This article is particularly relevant in the clinical context because it provides not only a health care framework but also a social framework for providing care for HIV-positive children. The need for having a completely different approach when handling HIV-positive children is well argued out using facts and figures in this paper. Yet the lack of data with respect to children's and parents' responses to the issue make this study hierarchical. For example, Altmaeir and Hansen (2011) have reminded the improtance of “patient-centered communication” as a resource while planning research in counselling psychology (p.744). Similarly, this paper has not given attention to differentiate the HIV-children's groups based on their socio-economic status. There can be crucial differences between the care situations of socially and economically well-off children and backward children. Many of the child-centered and caretaker-centered issues identified by this study could possibly be attributes of this demographic status as well. For example, the unwillingness to disclose details of the condition of the child and to permit tests to be carried out, often is seen in less educated parents, who are economically backward as well (Myers et al., 2001, p.274). Especially in a developing country like Uganda, many health care situations will have as their root cause, poverty. This article prompts further investigations into the areas mentioned above. The care situation of socio-economically backward HIV-positive children in Uganda is a topic worth pondering further. Similarly, a study based on the responses of HIV-positive children and their parents will also add valuable information to what have already been revealed by this study. This paper needs to be considered by the policy makers of Uganda so that they can modify policies in a constructive manner to provide better care to HIV-positive children with respect to counselling and testing. This study can also by taken up by international monitoring agencies of health care so as to assess the general situation in developing countries. To conclude, this paper provides information on the general lack of training and institutional facilities in health care sector in Uganda. Though this study is centered around HIV alone, it gives a general picture as well. The lack of training, lack of counselling skills and lack of institutional facilities will have an impact on the morale of the health care professionals involved. This problem should be able to draw the attention of international and national non-governmental organizations to formulate policies and steps to tackle it effectively. Only through such steps could we expect to provide better health care to our children, especially the unfortunate ones infested with HIV. References Altmaeir, E.M. and Hansen, J.C. (2011) The Oxford handbook of counselling psychology, Oxford: Oxford University Press. Rujumba, J., Mbasaalaki-Mwaka, C.L. and Ndeezi, G. (2010) Challenges faced by health workers in providing counselling services to HIV-positive children in Uganda: A descriptive study, Journal of the International Aids Society, 13 (9), pp.1-9. Myers et al., (2001) The APSAC handbook on child maltreatment, London: SAGE. Read More