Task-shifting HIV counselling and testing services in Zambia

Task-shifting HIV counselling and testing services in Zambia: the role of lay counsellors

The human resource shortage in Zambia is placing a heavy burden on the few health care workers available at health facilities. The Zambia Prevention, Care and Treatment Partnership began training and placing community volunteers as lay counsellors in order to complement the efforts of the health care workers in providing HIV counselling and testing services. These volunteers are trained using the standard national counselling and testing curriculum. This study was conducted to review the effectiveness of lay counsellors in addressing staff shortages and the provision of HIV counselling and testing services. Quantitative and qualitative data were collected by means of semistructured interviews from all active lay counsellors in each of the facilities and a facility manager or counselling supervisor overseeing counselling and testing services and clients. At each of the 10 selected facilities, all counselling and testing record books for the month of May 2007 were examined and any recordkeeping errors were tallied by cadre. Qualitative data were collected through focus group discussions with health care workers at each facility. Lay counsellors provide counselling and testing services of quality and relieve the workload of overstretched health care workers. Facility managers recognize and appreciate the services provided by lay counsellors. Lay counsellors provide up to 70% of counselling and testing services at health facilities. The data review revealed lower error rates for lay counsellors, compared to health care workers, in completing the counselling and testing registers. Community volunteers, with approved training and ongoing supervision, can play a major role at health facilities to provide counselling and testing services of quality, and relieve the burden on already overstretched health care workers.

is more than an order-of-magnitude (10 times) below the recommended staff-to-population ratios for nurses (1:700 versus 1:8064) and pharmacists (1:8000 versus 1:473,000), spurring it on to find solutions to this health care bottleneck. A two-week classroom component followed by a four-week supervised practicum and training in finger-prick HIV testing has created a cadre of lay counsellors providing quality services to satisfied clients. Some lay counsellors view reducing stigma and representing community role models as additional responsibilities. The fact that this is a voluntary programme (lay counsellors receive 25USD per month to defray travel costs but no other compensation) may jeopardise its sustainability. Continued supervision of the work of these lay counsellors, along with formalisation of their relationship with health facilities, could enhance both performance and retention.