Table 1 Barriers and facilitators that are modifiable at the policy level
Level | Domain | Barriers | Facilitators |
|---|---|---|---|
Central | Service structures | • Inconsistent requirements and procedures between MMT and HIV services (staffing, renumeration, medical dispensing, health insurance) • Multiple management units (district vs. province) • Separate patient record systems | • Step-by-step instructions for implementation at the district and province levels • Revised medical dispensing schedule • Unified patient record system |
Staffing structures | • None | • Transition of staff from program status to government employee status | |
DOH and clinic directors | Service structures | • Lack of legal framework for integration • Inconsistent requirements and procedures between MMT and HIV services (common prices, health insurance, certification) • Multiple management units | • Legal framework and regulations for providing integrated MMT and HIV services • Provision of health insurance for both MMT and HIV services |
Staffing structures | • Lack of full-time, permanent staff and inability to attract external human resources • Lack of renumeration that is commensurate to increased responsibilities • High-risk working environment | • None | |
Clinic providers | Service structures | • Inconsistent requirements and procedures between MMT and HIV services (staffing, renumeration, medical dispensing, health insurance) • Lack of unified reporting system | • None |
Staffing structures | • Lack of renumeration that is commensurate to increased responsibilities (high workload) • Lack of staff and inability to attract external human resources • Lack of government staff positions and program staff treated differently • High-risk working environment | • None |