Table 2. Weighting of benefits and challenges of differentiated models of care1.
| Model of Care / Type of Feedback Provided | Frequency weighting2 by health workers | Frequency weighting2 by patients | Impact weighting3 according to policy makers | Overall weighting4 |
|---|---|---|---|---|
| MMS | ||||
| Successes and benefits | ||||
| Reduced burden on patients | 2 | 3 | 4 | 20 |
| Reduced workload for health workers and congestion in facilities | 2 | 1 | 5 | 15 |
| Improves patient adherence and retention due to reduced burden of care | 3 | 0 | 4 | 12 |
| Acts as incentive for good adherence or to seek services | 1 | 1 | 4 | 8 |
| Helps patients to maintain confidentiality | 0 | 1 | 2 | 2 |
| Patients felt comfortable seeking services between appointments if needed | 0 | 1 | 3 | 3 |
| Challenges | ||||
| Low stocks of ARVs | 1 | 2 | 5 | 15 |
| Patients failing to seek care when sick between appointments | 2 | 0 | 5 | 10 |
| Perception that patients are more likely to forget spaced out appointments | 2 | 0 | 5 | 10 |
| Low stocks and stock outs of cotrimoxazole limiting implementation | 1 | 2 | 3 | 9 |
| Preference for refills of longer than three months | 0 | 3 | 2 | 6 |
| Differences in implementation across facilities | 0 | 1 | 2 | 2 |
| FTR5 | ||||
| Successes and benefits | ||||
| Reduced waiting time for patients | 0 | 3 | 5 | 15 |
| Reduced workload for clinicians | 2 | 1 | 4 | 12 |
| Challenges | ||||
| Transitioning patients out of FTR program when they become unstable | 2 | 0 | 4 | 8 |
| Lack of patient understanding of model of care | 1 | 0 | 3 | 3 |
| Perceived long waiting time for refill visits | 0 | 1 | 2 | 2 |
| CAG | ||||
| Successes and benefits | ||||
| Improves patient adherence and retention in care due to social support | 3 | 2 | 4 | 20 |
| Reduced travel time and burden | 0 | 3 | 4 | 12 |
| Encouragement of members to seek care when sick | 1 | 1 | 4 | 8 |
| Increased social support | 0 | 2 | 4 | 8 |
| Reduced space issues and facility congestion | 2 | 0 | 3 | 6 |
| Development of insurance and other financial support systems | 0 | 1 | 1 | 1 |
| Challenges | ||||
| Misunderstandings or relationship problems within groups | 3 | 2 | 3 | 15 |
| Limited ability for health workers to monitor patient adherence and status | 3 | 0 | 4 | 12 |
| Patient concerns about privacy | 2 | 2 | 3 | 12 |
| Transitioning patients out of CAG program when they become unstable | 2 | 0 | 3 | 6 |
| Difficulties in establishing group | 0 | 2 | 3 | 6 |
| Lack of education for and understanding of patients about CAG model | 0 | 2 | 3 | 6 |
| Lack of training for and understanding of health workers about CAG model | 1 | 0 | 4 | 4 |
| Lack of resources for supervision | 1 | 0 | 4 | 4 |
| Perceived low male participation | 1 | 0 | 1 | 1 |
Notes
1. This table is based on qualitative data from the process evaluation and consultation with government officials about the impact or importance of each item. Because of the nature of qualitative data collection as in-depth, guided conversations on a topic, it is not possible to take a strictly quantitative approach to assessing the issues raised. Rather, we have attempted to give a general weighting for how often an item was raised in qualitative data and how important the item is to the success of the model, according to the MOH.
2. Frequency Weighting: This is a measure of how often a particular issue was raised or how many participants shared the view in interviews with health care workers (HCWs) or focus groups with patients. A frequency weighting of three reflects that the issue was raised in more than half of interviews or focus groups in sites offering the model. A frequency weighting of two or one reflect that the issue was raised in 25–50% or less than 25% of sessions in sites offering the model, respectively.
3. Impact Weighting: This is a measure applied by the study team in consultation with the MOH (as opposed to study participants) of the degree to which policy makers believed that item had potential to influence the overall success of the models and its goals if the issues were to be realized.
4. Overall Weighting: The overall weighting is calculated as the sum of the patient and health worker frequency weightings multiplied by the impact weighting.
5. Note that the benefits and challenges of MMS apply to FTRs also. But under FTRs the only benefits and challenges listed are the ones that are in addition to or different from the MMS issues.