Health Policy and Planning Advance Access originally published online on March 30, 2007
Health Policy and Planning 2007 22(3):139-148; doi:10.1093/heapol/czm006
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‘We are also dying like any other people, we are also people’: perceptions of the impact of HIV/AIDS on health workers in two districts in Zambia
1Royal Tropical Institute, Amsterdam, the Netherlands.
2Churches Health Association of Zambia, Lusaka, Zambia.
3Employed by the Churches Health Association of Zambia during the research.
4Radboud University Medical Centre, Nijmegen, the Netherlands.
* Corresponding author. KIT Development, Policy and Practice, Royal Tropical Institute, P.O. Box 95001, 1090HA Amsterdam, the Netherlands. Tel: +31 20 56 88 658; Fax: +31 20 56 88 677; E-mail: m.dieleman{at}kit.nl
In countries with a high AIDS prevalence, the health workforce is affected by AIDS in several ways. In Zambia, which has a prevalence rate of 16.5%, a study was carried out in 2004 with the aim to: explore the impact of HIV/AIDS on health workers, describe their coping mechanisms and recommend supportive measures. The qualitative study was complemented by a survey using self-administered questionnaires in four selected health facilities in two rural districts in Zambia, Mpika and Mazabuka. It is one of the few studies to have explored the impact of HIV/AIDS from the perspective of health workers and managers in the region.
Thirty-four in-depth interviews and five group discussions were conducted with health workers, managers and volunteers, and 82 self-administered questionnaires were filled out by health workers. In addition, burnout among 42 health workers was measured using the Maslach Burnout Inventory (MBI). The MBI measures three components that contribute to burnout: emotional exhaustion, depersonalization and personal accomplishment.
The results show that in both districts, HIV/AIDS has had a negative impact on workload and has considerably changed or added tasks to already overburdened health workers. In Mpika, 76% of respondents (29/38), and in Mazabuka, 79% (34/44) of respondents, expressed fear of infection at the workplace. HIV-positive health workers remained ‘in hiding’, did not talk about their illness and suffered in silence. Despite the fact that health workers were still relatively motivated, emotional exhaustion occurred among 62% of the respondents (26/42). The interviews revealed that counsellors and nurses were especially at risk for emotional exhaustion. In each of the selected facilities, organizational support for health workers to deal with HIV/AIDS was either haphazardly in place or not in place at all. AIDS complicates the already difficult work environment. In addition to health workers, management also needs support in dealing with AIDS at the workplace.
Key Words: Impact of HIV/AIDS, health workers, managers, perceptions, fear, emotional exhaustion, stigma, organizational support, HIV/AIDS workplace policies and programmes, Zambia
Accepted for publication 9 January 2007.