OpiniãoEven when there is a strong consensus on policies and codes of practices related to HIV and TB in health workers, actual Guidelines and Codes of Practice in this regard are not widely available or accessible, nor are training materials in this area, and are not being widely implemented.
Budgets for training and material inputs are generally lacking, and require attention.
Guidelines and codes of practice related to health workers, HIV and TB must be widely available and accessible. Training materials in this area must also be widely implemented and available for all front-line workers, management and other key stakeholders. Dissemination should be systematic (for distribution, orientation, training, monitoring and feedback) and policy distribution must be undertaken across all sectors.
Political "territorism" of sectoral ministries should be considered and avoided by ensuring that codes of practice clearly specify roles and responsibilities for all parties (from the various units within Health and Labour ministries and departments, to hospital-based personnel including experts in human resources, infection control, HIV, TB, public health and occupational health, and others as appropriate, such as reproductive health for specific functions)
While clinical guidelines regarding the diagnosis and treatment of HIV and TB exist in abundance, there is a lack of internationally accepted guidelines and codes of practice for implementation for healthcare workers at the level of health facilities.
Whelan and colleagues (2008) analyzed 14 recognised codes and guidelines to gain an understanding of the theoretical consensus regarding the key components of best-practice workplace HIV interventions. Nine key components of best practice were drawn from the analysis; interviews aimed to verify these components by determining the extent to which HIV practitioners in South Africa share a similar understanding of best practice. There was a high level of agreement between the practitioners who were interviewed and the codes and guidelines that were analysed concerning what best practice entails. However, reported usage of the recognised codes and guidelines to inform workplace HIV interventions was low.
Mahajan and colleagues (2007) had also noted that although the legal apparatus establishes the groundwork for employers to develop workplace policies, further guidance on operationalizing the legal provisions and developing comprehensive programmes are needed. The South African Code of Good Practice on HIV and Key Aspects of Employment (1998) was developed by the South African Department of Labour in consultation with national trade unions, and Technical Assistance Guidelines were produced that offer a step-by-step tool for managers and unions to cooperatively develop local policies and programmes. Although available evidence demonstrates uneven awareness and adoption of the provisions, no research has been conducted to ascertain the reasons for this. Likely the insight provided by Corbett's 5-Country Study provides some answers in this regard, as noted below.
Some materials have been produced by trade unions, and their international organization, Public Service International, as discussed above. Trade unions and health and safety committees have an important role to play in this area, as will be discussed further with respect to Statement 8.
The WHO Survey presented the following conclusions relevant to the dissemination of policies in the form of guidelines and codes of practice: Overall, there was no wide dissemination of policies; a scheduling plan is not comprehensive and not consolidated; costing has been undertaken in some of the countries, but is still lacking; and overall management of dissemination and implementation of policies needs attention
The 5-country study by Liz Corbett also identified substantial gaps in the implementation of current policies, especially in regards to health workers' entitlements, rights, and access to HIV/TB prevention, testing and care due to lack of information or resources, and unclear or absent allocation of responsibility. The study noted that even when good policies exist at the national level, they often do not filter down to the facility as a consequence of lack of training, inadequate information and insufficient documentation providing guidance on how to implement the policies.