Sources of motivation and frustration among healthcare workers administering antiretroviral treatment for HIV in rural Zimbabwe

Abstract

The roll-out of accessible and affordable antiretroviral (ARV) drugs for people living with HIV in low-income countries is drastically changing the nature of HIV-related healthcare. The Zimbabwean Ministry of Health has renewed efforts to make antiretroviral treatment (ART) for HIV free and publically available across the country. This paper describes the findings from a multi-method qualitative study including interviews and a focus group with healthcare workers (mostly nurses), totalling 25 participants, and field notes from over 100 hours of ethnographic observation in three rural Zimbabwean health centres. These health centres began providing free ARV drugs to HIV-positive people over one year prior to the research period. We examined sources of motivation and frustration among nurses administering ART in these resource-poor health centres. The findings suggest that healthcare workers administering ART in challenging circumstances are adept at drawing strength from the dramatic physical and emotional recoveries made possible by ART and from their personal memories of the suffering caused by HIV/AIDS among close friends or family. However, healthcare staff grappled with extreme resource shortages, which led to exhaustion and frustration. Surprisingly, only one year into ART provision, healthcare workers did not reference the professional challenges of their HIV work before ART became available, suggesting that medical breakthroughs such as ART rapidly come to be seen as a standard element of nursing. Our findings provide a basis for optimism that medical breakthroughs such as ART can reinvigorate healthcare workers in the short term. However, we caution that the daily challenges of nursing in poor environments, especially administering an ongoing and resource-intensive regime such as ART, must be addressed to enable nurses to continue delivering high-quality ART in sub-Saharan Africa.

Keywords:

• antiretroviral treatment
• human resources for health
• HIV nursing
• healthcare worker motivation
• Zimbabwe

Acknowledgements

The authors are grateful to all the research participants. We also wish to thank Cynthia Chirwa, Samuel Mahunze, Edith Mupandaguta, Reggie Mutsindiri, Kundai Nhongo, Zivai Mupambireyi and Simon Zidanha for logistic, translation, transcription and research assistance. Morten Skovdal provided generous assistance with data analysis. This work was supported by the Wellcome Trust.

Notes

1. A clinical officer is trained for three years and is licensed to prescribe medicine and initiate ART in Zimbabwe.