Assessment of Effective Coverage of Voluntary Counseling and Testing Mohammed H.et al 9 ORIGINAL ARTICLE ASSESSMENT OF EFFECTIVE COVERAGE OF VOLUNTARY COUNSELING AND TESTING SERVICES IN MAJOR HEALTH FACILITIES OF JIMMA ZONE, SOUTH ETHIOPIA Mohammed Hussein1, Challi Jira2, Belaineh Girma3 ABSTRACT BACKGROUND: Coverage assessment of Voluntary Counseling and Testing (VCT) service is useful to measures the health system effort or performance of health service delivery function and to influence decisions. The objective of this study was to assess effective coverage level for Voluntary Counseling and testing services in major health facilities of Jimma Zone. METHODS: Health institution based cross-sectional quantitative and qualitative study on health facilities that provide voluntary Counseling and testing services. RESULTS: The over all HIV/AIDS service package indicators availability coverage were 45.5% across the zone. The over all coverage for target population were 1.3%. The primary health care centers served only 18% of total registered Voluntary Counseling and Testing service users. Out of total positive sero- status clients, only 5% received condom. The coverage for post result counseling was 98.7% for all tested clients. Seventy-four (1.3%) of clients who were tested for HIV did not returned to know their results. CONCLUSION: This study demonstrated that effective coverage of Voluntary Counseling and Testing service was very low based on the providers view and records available. Thus we recommended that the services has to be strengthened, supervised and monitored to have a better achievement and improving the coverage status in addition to scaling up the services in the Zone. KEYWORDS: Effective coverage, availability, utilization, quality, VCT services INTRODUCTION HIV/AIDS is the most far-reaching and damaging epidemic the world has ever seen. Within a single Good health is both an investment and consumption generation, it has grown into an individual and goods. It is an investment goods because it enables societal tragedy with huge implications for human people to engage in the production process security, for social and political stability and for effectively and consumption goods because it economic development (2). enables people to enjoy to its full extent with out pain. Ill-health leads to loss in productivity and In all affected countries the HIV/AIDS time put in to production, resulting in poverty leads epidemic is bringing additional pressure to bear on to poor living condition, malnutrition and illiteracy, the health sector. As epidemic matures, the demand there by leading to ill-health, hence the vicious for care for those living with HIV/AIDS rises. cycle of ill-health and poverty. But one way of Health care service faces different level of strain, ensuring good health services is accessible to all depending on the number of people who seek people by increasing coverage and utilization (1). services, the nature of the need, and the capacity to deliver that care (3). --------------------------------------------------------- 1Ministry of Health, Addis Ababa, 2Jimma University, College of Public Health and Medical Sciences, P. O. Box 378, Jimma, 3Addis Continental Institute, Addis Ababa. 10 Ethiop J Health Sci. Vol. 21, Special issue August, 2011 The health sector can play a unique role in supervision. Furthermore, each question included in delivering prevention and care interventions the questionnaire was discussed in detail. In record through a range of health services and can use review of first visits of VCT and ART services was varied entry point for reaching out to people in used in data collection. In depth interview were need. Most national programs seek to achieve their conducted with Heads of the district health offices, goals by expanding access to information and to health facilities, and with the counselors using in- high quality services for every one who need them. depth interview guide questions in Amharic One measure of how well a program is performing language to keep the communication uniform is the coverage level it achieves. among all key informants. Since the start of HIV/AIDS prevention and HIV/AIDS service effective coverage was care intervention programs of VCT, there was no measured by the number of people received the effective coverage assessment done in previous service in the year using service statistics provided years in the Jimma Zone. This short coming in 2005 and corresponding to projected population necessitated the importance of the study. Thus, The needing the service in the same year. The proposed objective of this study was to assess the effective measurement of HIV/AIDS intervention would be coverage of VCT in terms of service availability, by use of coverage indicators domains: utilization, continuity and quality in order to know Availability, Utilization, Continuity and Quality. how well the programs are serving those who need Availability indicators to measure access for VCT them. used in the study were availability of service site, condom, sexually transmitted diseases (STD) drugs, METHODS HIV test kits, antiretroviral therapy (ART) drugs, referral support network, and the availability of The study was conducted in Jimma Zone which is long-term support. situated in South West of the Federal capital Addis Utilization indicators to measure acceptability for Ababa and administratively has 13 districts. VCT used in the study were use of HIV test HIV/AIDS prevention and care service provision in counseling and HIV test. Jimma Zone is through governmental and non Continuity indicators for VCT used in the study governmental organizations (NGOs) that includes was use of family planning by HIV positive VCT services in 8 health centers, 2 hospitals and 2 individuals, post test counseling, condom provided, NGOs. The study was conducted from January – clients referred to ART and support by April 2006. organizations. The study design was health institution based Quality indicators for VCT used in the study were quantitative and qualitative cross-sectional study to existence of policy document, plan and national determine effective service coverage of VCT guidelines, number of service provider received services in hospitals, health centers and NGOs of training, safety precaution followed by service Jimma zone. The source of the study population providers. includes health facilities that provided VCT and The quantitative data was analyzed using step-by- ART services. Study population or subject for step approach explained in literature. The responses quantitative study included Jimma university were edited before analysis, coding of certain specialized hospital, Limmu district hospital, two variables was done. Data was entered and NGOs and 50% of public health centers that processed using the Statistical Package for Social provide HIV/AIDS prevention and care related Science (SPSS) for window version 12.0. First services and records of clients of VCT that was descriptive statistics was used which included provided from January 1st to December 31, 2005. frequency, mean, median and others. Then bivariate The study population or discussants for qualitative and multivariate analysis was done. Chi square test was facility heads, district health office heads and was used for hypothesis testing and p-value of counselors in respective health facility. below 5% taken as significant. Odds ratio with 95% Data collectors and supervisors were selected CI was used to know relationship of variables. on the basis of their experience in health service The qualitative data was transcribed, provision. Data collectors for the interview were translated, coded and categorized by using study health personnel who were not involved in VCT, themes as a guide and then grouped the data around PMTCT and ART services. Semi structured the themes. Differences and similarities between questionnaire was developed and used in this study. the answers have to be examined. Training topics included: discussion on the study Questionnaire was developed based on WHO objectives, methods of data collection and field effective coverage assessment guideline. The Assessment of Effective Coverage of Voluntary Counseling and Testing Mohammed H.et al 11 developed instrument was pre-tested before the 36.9% were unemployed and 29.6% were students actual data collection period. Based on finding of (Table 1). pre-test, questionnaire was revised. During data Service Availability collection close supervision was carried throughout The presence of package varies from five (35.7%) the periods by supervisors and principal to ten (71.4%) among the facilities. The highest investigator after giving them necessary orientation (71.4%) HIV/AIDS service package were reported on the tools of the study. The completed in Jimma University specialized hospital and the questionnaires were checked for each question lowest (35.7%) were reported in Serbo, Sokoru and items and variables at regular intervals. Data was FGAE health facilities. The over all HIV/AIDS cleaned and entered by investigator using SPSS service package indicators availability coverage version 12. was 45.5% across the study facilities (Table 2). Permission to conduct the study was obtained Respondents who were in public health from ethical clearance committee of Jimma facilities said that “the availability of VCT/PMTCT University, consent paper from Jimma Zone Health and ART services had negative impact by Office, District Health Offices, Health Centers, compromising the other