Perceptions and barriers on the feasibility of decentralizing the collection of blood samples for testing in the community through the community art group model in Lusaka, Zambia.

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Siwingwa, Mpanji
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The University of Zambia
The focus of Community ART Group (CAG) model is on drug refill, adherence and support groups. The laboratory services are completely neglected in implementing this model in Zambia, and stable patients still have to go to the clinic for blood draws after collection of drugs from the community. In addition, phlebotomy delivery system is congested and has challenges with shortage of staff, insufficient funding, shortages of supplies and delivery services. The purpose of this study was to identify the perceptions, barriers and potential resources in decentralizing the collection of blood samples for routine testing into the CAG model. A qualitative case study design was used. Data was collected through ten Focused group discussions among CAG members, community and health care workers at ART clinics and in-depth interviews with five key informants. Data was analyzed using thematic method and this was done with the help of Nvivo version 10. Positive perceptions were identified as those which contributed to decongesting phlebotomy rooms, reduced missing appointments for blood draws, work Load, and lost results. Improved quality of phlebotomy service delivery and testing coverage, innovative way of bringing lab services closer to the people and inspire patients to monitor each other’s blood draws. The negative perceptions were compromised sample integrity and less contact with clinicians. The study also identified barriers to decentralize phlebotomy services within CAG and these included: long distance and transportation costs, inadequate community sensitization, lack of skills from the community to draw quality samples for testing, lack of privacy and confidentiality, CHWs not recognized by regulatory bodies, low level of literacy, shortage of qualified health workers and lack of remunerations. In summing up, the clinical psychosocial counsellors, volunteers, CHWs and HCWs were identified by all stake holders as prospective community phlebotomist in the decentralization of phlebotomy services. Decentralizing phlebotomy services into CAG model was perceived as decongesting and reducing work in the phlebotomy room, improved testing coverage and compromised sample integrity. This process incurred challenges due to lack of community sensitization and technical skills in phlebotomy, transportation cost and community health workers not recognition by regulatory bodies. The potential resources needed in community phlebotomy services were identifying prospective phlebotomist, materials for community sensitization, trainers and training materials, experts in quality assurance programs and financial support.
Thesis of Master of public health in Health Policy and Management.