The Study On The Feasibility Of HIV/AIDS Prevention Services And Manpower Allocation As Well As Financial Demands In Community Health Service Center

Objective:To examine the feasibility and its influencing factors of HIV/AIDS (Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome) prevention services and manpower as well as financial demands in Community Health Service Center (CHSCs), and to explore the cooperation of HIV/AIDS services with the basic public health service so as toprovide scientific evidence for the improvement of HIV/AIDS prevention and control system.Methods:Four or five CHSCs were selected in this study from Guangzhou, Shanghai, Nanjing, Changsha, Chongqing and Hangzhou city. The study has three pronged approaches:(1) Using the framework of Health Policy Triangle, literature review, qualitative and quantitative studies were combined to examine the context factors including HIV/AIDS health policies, epidemic status, distribution and characteristics of HIV/AIDS services and HIV/AIDS prevention practice, and to learn the acceptance, supportability of key informants related to HIV/AIDS prevention practice in CHSCs; Altogether 274 health workers and 610 participants from 6 cities were included in the qualitative survey and 101 key informants were interviewed from Guangzhou, Nanjing and Changsha city; Besides, a total of 78 literatures and 18 policy documents in national, provincial and municipal levels were reviewed systematically; (2) Including all influencing factors of HIV/AIDS prevention services in CHSCs into the Health System Macro-Model and set up the hierarchical structure, then the Analytic Hierarchy Process (AHP) method was employed to determine the importance of all factors and find out the key factors. (3) Using Activity-Based Costing method, the unit cost, manpower allocation and financial demands for HIV/AIDS prevention services in CHSCs were studied.Results:From the aspects of context and content of Health Policy Triangle, there is feasibility of HIV/AIDS prevention services in HIV/AIDS policy, epidemic control, distribution and characteristics of HIV/AIDS services and HIV/AIDS prevention practice. CHSCs can take on HIV/AIDS health education, high risk behavior intervention, HIV/AIDS counseling and testing and HIV/AIDS case management services. From the viewpoint of key informants,67.4%of HIV/AIDS service providers were likely to support the HIV/AIDS prevention work in CHSCs, while lack of financial support and coordination, with many tasks, fear of occupational exposure, discrimination against people living with HIV/AIDS (PLWHA) and low salary status remain to be barriers to their supportability for HIV/AIDS prevention services in CHSCs; Most participants were likely to accept HIV/AIDS prevention services in CHSCs and fear of discrimination and disclosure of personal privacy,distrust of service level and lack of HIV/AIDS knowledge were its influencing factors.The result of AHP indicated the key influencing factors of HIV/AIDS prevention services include manpower quality, manpower number, financial input, recognition of service providers, policy support, leadership of CHSCs, service environment and skill level of service providers in CHSCs; The manpower allocation and financial input were structural factors with high weight coefficient.The results of manpower allocation study indicates that the current manpower of HIV/AIDS services in CHSCs in Guangzhou, Shanghai, Nanjing, Changsha, Chongqing and Hangzhou city is limited in 2012 and can’t meet the HIV/AIDS service demands with part-time providers. Calculation based on the HIV/AIDS service activity center, the standard manpower demand for CHSC in six cities is 2.0,4.0,2.5,1.2,2.1 and 3.8 persons respectively, with an average of 2.6 persons; In financial demands, each CHSC need 156,659.00 Yuan,472,964.41 Yuan,131,080.65 Yuan,72,264.40 Yuan,119,225.77 Yuan and 268,205.38 Yuan in Guangzhou, Shanghai, Nanjing, Changsha, Chongqing and Hangzhou city in 2012 to fulfill all the HIV/AIDS service items in activity center. The current financial input for HIV/AIDS prevention services is lower that of the service demands level.Conclusions:There is policy basis and feasibility in practice to transfer the HIV/AIDS prevention services downwards to CHSCs, a specific HIV/AIDS service regulation should be worked out according to the HIV/AIDS epidemic level of each city. Meanwhile, it must be accompanied by measures such as HIV/AIDS financial input, work team construction, technological support, advocation of privacy and zero-discrimination by service providers, thus make the HIV/AIDS prevention services sustainable in CHSCs in the long run.