Understanding health facility challenges in the implementation of Option B+ guidelines in Ghana: the perspectives of health workers

Alexander Suuk Laar, Philip Ayizem Dalinjong, Clarice Ntim-Adu, Judith Akworkor Anaman-Torgbor


Background: Ghana initiated the implementation of the WHO consolidated guidelines for the Option B+ prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) guidelines. This study explored health workers (HWs) views on health system challenges in the implementation of the new guideline at the health facility settings.
Methods: We conducted a facility-based qualitative study in April 2016. In-depth interviews were carried out with healthcare providers (n=17) at the PMTCT clinic at the Greater Accra Regional Hospital (GARH). These participants were purposively selected based on their roles at the PMTCT clinic. Their voluntary participation was assumed after they have provided verbal consent to participate in the study. The interviews were audio-taped and transcribed verbatim. The data was analyzed using thematic framework approach.
Results: The findings of this study revealed that healthcare providers had deep knowledge of the Option B+ guidelines. These reflected in their definitions and the importance of the guideline for the likely health outcomes for the mother and the baby. Despite its benefits, the participants also lamented of the challenges they encounter in their day to day delivery of the services. The main barriers included inadequate counsellors, inadequate working space, limited laboratory capacity and lack of means of transport for monitoring and evaluation activities.
Conclusions: The findings show that Option B+ holds great promise for improving the health outcomes for HIV-infected women and their babies. This study calls for the need to develop strategies to address the health system constraints for the scalability and sustainability of the Option B+ programme by incorporating the findings of this study in policy formulation.