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Open Access Research article

A qualitative exploration of the human resource policy implications of voluntary counselling and testing scale-up in Kenya: applying a model for policy analysis

Miriam Taegtmeyer1*, Tim Martineau2, Jane H Namwebya3, Annrita Ikahu4, Carol W Ngare5, James Sakwa6, David G Lalloo1 and Sally Theobald2

Author Affiliations

1 Clinical Group, Liverpool School of Tropical Medicine, Liverpool, UK

2 International Health Group, Liverpool School of Tropical Medicine, Liverpool, UK

3 Family Health International, Nairobi, Kenya

4 Counselling Department, Liverpool VCT, Treatment & Care, Nairobi, Kenya

5 Quality Assurance Coordinator, National AIDS and STD Control Programme, Nairobi, Kenya

6 Elected Chair, Association of Kenya Medical Laboratory Scientific Officers, Nairobi, Kenya

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BMC Public Health 2011, 11:812  doi:10.1186/1471-2458-11-812

Published: 18 October 2011

Abstract

Background

Kenya experienced rapid scale up of HIV testing and counselling services in government health services from 2001. We set out to examine the human resource policy implications of scaling up HIV testing and counselling in Kenya and to analyse the resultant policy against a recognised theoretical framework of health policy reform (policy analysis triangle).

Methods

Qualitative methods were used to gain in-depth insights from policy makers who shaped scale up. This included 22 in-depth interviews with Voluntary Counselling and Testing (VCT) task force members, critical analysis of 53 sets of minutes and diary notes. We explore points of consensus and conflict amongst policymakers in Kenya and analyse this content to assess who favoured and resisted new policies, how scale up was achieved and the importance of the local context in which scale up occurred.

Results

The scale up of VCT in Kenya had a number of human resource policy implications resulting from the introduction of lay counsellors and their authorisation to conduct rapid HIV testing using newly introduced rapid testing technologies. Our findings indicate that three key groups of actors were critical: laboratory professionals, counselling associations and the Ministry of Health. Strategic alliances between donors, NGOs and these three key groups underpinned the process. The process of reaching consensus required compromise and time commitment but was critical to a unified nationwide approach. Policies around quality assurance were integral in ensuring standardisation of content and approach.

Conclusion

The introduction and scale up of new health service initiatives such as HIV voluntary counselling and testing necessitates changes to existing health systems and modification of entrenched interests around professional counselling and laboratory testing. Our methodological approach enabled exploration of complexities of scale up of HIV testing and counselling in Kenya. We argue that a better understanding of the diverse actors, the context and the process, is required to mitigate risks and maximise impact.