Table 3.
Organizational barriers related to CCMDD implementation
| Inadequate space |
| “To be honest, that filing room is getting smaller and smaller…because every day there are people being initiated…so we thought that it would be great if we would get a bigger filling to accommodate all the files because it seems like it’s going to be a lot of files for 2019 yet we are still halfway through the year.” (Data Clerk, Clinic Pick-up Point) |
| “Space is needed too for CCMDD to have its own space in this clinic… the space is small. We squeeze with other people… Privacy is also needed sometimes. For example, maybe someone has some to review but you find that they are sick on that day and they need privacy to tell you, one-to-one.” (Nurse, Clinic Pick-up Point) |
| “Our biggest challenge is storage…we do not even have adequate shelving space where we can store medication so that it can be sorted properly.” (Nurse, Clinic Pick-up Point) |
| Insufficient staffing |
| “Others got trained. I learned along the way because…I have never received any training.” (Nurse Assistant, Clinic Pick-up Point) |
| “Let’s say a person comes, let’s say like [NGO] and they say they are here to assist us you in the sites, only to find that they tell you they are now closing down…Now I am left all alone.” (Supervisor/Adherence Club Leader, Clinic Pick-up Point) |
| “…other clinics they had ART clubs but they didn't continue with them because there were no human resources to continue….” (Clinic Manager, Clinic) |
| Lack of resources: transportation |
| “The only problem that we experience at time is that fact that we share a vehicle with the clinic. You find that sometimes when we need to go out to pick up points, the vehicle is booked for something else. Sometimes when they have to fetch us you will find that they are still busy with something else.” (Lay Counsellor, Clinic Pick-up Point) |
| “The clinic has discontinued delivering medication to pick-up points because we were experiencing high levels of vehicle theft. This has resulted in trying to have pickup points closer to the facility where we are able to walk to…” (Adherence Club Facilitator, Clinic Pick-up Point) |
| “The reason [adherence clubs stopped] was the transport, because when the treatment was ready, the staff that was hired from [NGO] was delivering it. Then that staff from [NGO] would deliver it but the transport was not available here at the clinic, and [NGO] also didn’t have it. Patients would wait in those places until they decide to go back home. We saw that this will make the community to hate us, it's better to stop it because it wasn’t properly organized.” (Nurse, Clinic) |
| Lack of resources: computing |
| “When the [Wi-Fi data] ran out then we had to script them manually, so that makes work to be a lot whereas when there is a computer its easy. When you are hand-writing it takes time…” (Support/CCMDD Eligibility Screener, Clinic) |
| “But now the system is frozen, then you have to write the IDs down on a page. God knows sometime that page gets lost, then it’s not synced and it’s your fault… But it’s challenging, if the systems are not working, what can you do?” (Pharmacy Assistant, External Pick-up Point) |