Managerial factors influencing the implementation of NIMART services in the mobile health clinics of eThekwini municipality in KwaZulu-Natal

Abstract

Background: The mobile health clinics (MHCs) have been instrumental in rolling out Human Immunodeficiency Virus (HIV) care since they are an extension of Primary Health Care (PHC) services. The integration of HIV care into PHC services is reported as a structural facilitative factor for implementing nurse-initiated antiretroviral therapy (NIMART). The success of any health program relies heavily on management and support structure, hence managers' perspectives on the implementation of NIMART services in MHCs are deemed crucial. Aim: The study aimed to explore and describe the managerial factors influencing the implementation of NIMART services in the MHCs of eThekwini municipality in KwaZulu Natal. Methods: A generic qualitative research approach was used applying Qualitative Exploratory Descriptive (QED) design, on twelve MHC managers who were purposefully selected and managing MHCs operated by local and provincial health authorities. The study was approved by the North-West University Human Research Ethics Committee (NWU 00934-19-A1), provincial (KZ_202002_017) and local health (30/1/1/6/3/1) authorities. Online semi-structured interviews were conducted to collect data and were transcribed. Atlas-TI was used for data analysis while demographic data was descriptively analysed. Results: Three themes and twelve subthemes emerged from the study: theme 1: Challenges in implementing NIMART services in MHCs, theme 2: Positive factors influencing implementation of NIMART services in MHCs, and theme 3: Suggestions to strengthen implementation of NIMART services. Subthemes were shortage of staff, shortage of medical equipment for NIMART services, challenges with infrastructure, lack of budget for NIMART services, nurses are trained in NIMART, continuous meetings, Proper planning, more nurses should be trained on NIMART, employment of more nursing personnel, collaboration with relevant stakeholders, proper infrastructure for NIMART and need for allowances. Conclusion: The involvement of managers is key to the successful implementation of NIMART services in the MHCs and improvement is more desirable.