Reducting Stigma and discrimination: A Self-Assessment Tool for Hospitals

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A Self-Assessment Tool for Hospitals and Other Medical Institutions

Caring for People Living with HIV/AIDS (PLHA) - India

Summary

Population Council/Horizons and Society for Service to Urban Poverty

(SHARAN) have developed a checklist to address AIDS-related

stigmatisation and discrimination within health care institutions in

an effort to improve services for people in India who are living with

HIV/AIDS (PLHA). Baseline findings from ongoing research informed the

development of this self-assessment tool, which is designed to help

managers and health care workers identify and address institutional

strengths and weaknesses related to care for PLHA.

Main Communication Strategies

Organisers conducted an operations research study in three New Delhi

hospitals (one private; two government-run). Formative research

revealed that PHLA and their caregivers report receiving differential

treatment, relative to other patients, that limits their access to

care. The study team also found in the baseline survey that within

the health care setting, misconceptions about HIV transmission,

negative attitudes about PLHA, inadequate training and supplies for

infection control, and lack of institutional policies on

confidentiality and HIV testing all exist and may exacerbate

inequality in treatment.

As part of the study, a practical Checklist was developed that can be

used by managers and other staff to identify institutional strengths,

pinpoint problems, and set goals for improvement of services for PLHA

and staff safety. In India, the title of the Checklist, which will be

distributed to all government medical facilities throughout India,

is " Self-assessment Checklist for Institutions Caring for PLHA. " A

generic form of this tool, entitled " The PLHA-Friendly Achievement

Checklist " , is available in hard-copy or PDF format.

The Checklist is designed in a simple format that can be adapted to a

variety of institutional settings, and may be used by individual

managers or by groups of managers and/or staff. Users of the

Checklist can use hospital records, survey data, observations, or

simply estimates to rate their own institution on each of five broad

domains:

Access to Care Services

Testing and Counseling

Confidentiality

Infection Control

Quality of Care

Within each of these domains, there are four sub-domains: practice,

training, quality assurance, and policy. There are between one and

five Checklist items under each sub-domain. For example, in the

infection control domain, under practice, one is asked to assess this

statement in the context of one's own institution: " Universal

precautions are practiced in the same manner with all patients at all

times. "

Using a participatory process that included discussion of the

baseline data and the self-assessment tools, managers at each

hospital worked with the project team to draft an action plan to

improve services for PLHA and working conditions for staff. The

action plans vary by hospital but include such actions as posting

information on universal precautions, training more health care

workers from each department in pre- and post-test HIV counseling,

and offering staff participatory sensitisation training on HIV/AIDS

that is designed and implemented by local AIDS organisations,

including their HIV-positive staff.

Development Issues

HIV/AIDS, Health, Rights.

Key Points

Stigma and discrimination against PLHA are reported to be severe in

many public and private hospitals in India, a problem that is likely

aggravated by insufficient training of health care workers, lack of

supplies to enact universal precautions, and inadequate policies.

" Gold standards " were compiled from national and international

guidelines and policies on the human rights of PLHA, HIV testing and

counseling, infection control, and care and management of HIV/AIDS.

These standards were reviewed and endorsed by the participating

National AIDS Control Organisation (NACO) and hospitals involved in

the study through a series of consultative discussions. These

standards, along with research data, informed the development of the

Checklist.

In the upcoming year, the project team will evaluate the intervention

by implementing a follow-up evaluation, and analysing pre-post data

and institutional progress on checklist scores and action plans. The

checklist will be revised for broader use in India at the end of the

project and will be distributed by NACO, along with the policy

guidelines. The generic version is available for use by any

institution or group providing clinical care for PLHA.

Partners

Population Council/Horizons, SHARAN, NACO.

Source

Population Council site; USAID HIV/AIDS E-Newsletter, January 28,

2003; Horizon Report, December, 2002.

For more information, contact:

Laelia Gilborn

Horizons

Population Council

4301 Connecticut Ave. N.W., Suite 280

Washington, DC 20008

Fax: 202-237-8410

lgilborn@...

OR

Vaishali Sharma Mahendra

Horizons

Population Council

53 Lodi Estate

New Dehli, 110003

India

Fax: 91-11-24610912

vmahendra@...

Source: http://www.comminit.com/pdskdv52003/sld-7794.html