Table 2 Barriers and facilitators that are modifiable at the programmatic level
Level | Domain | Barriers | Facilitators |
|---|---|---|---|
Central | Technical assistance | • None reported | • Human resource training and certification • Technical assistance to facilitate process |
Accountability | • None reported | • Renumeration for monitoring and evaluation | |
Local commitment | • None reported | • Local leadership buy-in informed by project evidence | |
DOH and clinic Directors | Technical assistance | • Lack of human resource training • Lack of integration model description • Patient discomfort sharing facilities with IDUs | • Human resource training and certification |
Accountability | • Lack of monitoring and evaluation reporting criteria | • Support from medical director and other medical departments • Social support network for clinic staff | |
Local commitment | • Lack of province-to-province learning opportunities | • None reported | |
Clinic providers | Technical assistance | • Limited knowledge of integrated services • Lengthy time lapse between training and clinic start-up • Disruptive IDU patient or drug seller behavior | • Human resource training and practice • Educational materials • Coaching support • Proactive information sharing between departments |
Accountability | • None reported | • Knowledge of clinic staff responsibilities • Proactive information sharing between departments • Collaborative work environment | |
Local commitment | • Lack of clinic staff buy-in | • Clinic engagement with community |