| Factors | Description |
| A hospital-centred and fully medicalized care system | Even if the program claims to consider the biopsychosocial dimension of the disease, in practice, it is the biological component of the disease that is concerned. The guidelines and standards are more developed according to the clinical aspect of the care. As discussed below, the psychosocial aspect is managed on a voluntary basis while the investments are made the most on the clinical aspect of the disease. In addition, the fact of centering care on hospital care raises the question of the opportunity cost of visits to FOSAs, knowing that most of the patients involved in the program are poor. “…insufficient information from Religious Leaders on HIV because the program does not discuss with them…” “…sick people often miss transportation to attend appointments…” HIV focal point “…most patients are destitute, and the program only covers laboratory tests and medication…” HIV focal point |
| Weak coordination of community care/PEC activities between the BCZS, the FOSA and the community worker | Low interest in community care evidenced by low accountability of FOSAs, community and program providers regarding community activities (community management tools, to whom should community workers report community data). Absence of formal relationships allowing the continuum of care between the FOSA and the community: lack of involvement of the PMTCT focal point in community monitoring. “…we do not have tools for collecting data on community interventions…” “…the BCZS does not support service providers and community relays and the latter are understaffed…” HIV focal point |
| Coordination of care between care units: maternity-prenatal consultation/CPN and postnatal consultation/CPON | In hospitals, the bipolarization of care between the CPN & PMI Unit and the maternity unit raises the question of the responsibility for monitoring women and children who are on ARVs. The discrepancy of data between these units weakens the establishment of a good database for home monitoring of women and children under treatment. In some health structures, there are community workers attached to the FOSA, called “Mother mentor”; but as presented below, “they are also volunteers and their action is generally limited to women who return to the FOSAs, not those who are lost sight of” HIV focal point |
| Overload of staff in charge of activities within the health structure and their low motivation | The care of HIV-infected women, particularly in its community action component, is for the health personnel, an additional burden on the usual clinical and administrative tasks in the FOSA. Even if financial incentives are mobilized for these personnel, some do not receive them, or receive them irregularly. Moreover, these incentives are not generally beneficial for these personnel; they are a transportation reimbursement. This assumes that without this transport, the motivation for this extra work is lost. “Being the IT manager and the one who coordinates the PMTCT activities, I work twice, yet I am not even paid but I am only reimbursed for transport while the PMTCT requires a lot to be done…” HIV focal point |
| Low communication time devoted to PLWHs in FOSAs | Staff responsible for PMTCT activities is overloaded. Already busy with the routine activities of the FOSA, this staff is also responsible for several administrative tasks which do not make them very available to devote more time to patients. It is not enough to do the screening and announce the result to require that the woman adhere to the program, but it is necessary to take time by an individualized work plan, likely to help the woman to confide and to be helped. FOSA staff are not initially trained in such approaches and these advisers are lacking in FOSAs. Insofar as they are available, they can constitute the relay between the personnel of the FOSA as well as those of the community to reinforce the communication with the women and to give them the chance to remain in the program. “…Explaining the benefits of the program several times and giving the patient confidence is important for women to adhere to the program…” HIV focal point “…the first contact can make the patient faithful or not to the activities…” HIV focal point |