Understanding the linkages between informal and formal care for people living with HIV in sub-Saharan Africa

Abstract

In response to the human resource challenges facing African health systems, there is increasing involvement of informal care providers in HIV care. Through social and institutional interactions that occur in the delivery of HIV care, linkages between formal and informal systems of care often emerge. Based on a review of studies documenting the relationships between formal and informal HIV care in sub-Saharan Africa, we suggest that linkages can be conceptualised as either ‘actor-oriented’ or ‘systems-oriented’. Studies adopting an actor-oriented focus examine hierarchical working relationships and communication practices among health systems actors, while studies focusing on systems-oriented linkages document the presence, absence or impact of formal inter-institutional partnership agreements. For linkages to be effective, the institutional frameworks within which linkages are formalised, as well as the ground-level interactions of those engaged in care, ought to be considered. However, to date, both actor- and system-oriented linkages appear to be poorly utilised by policy makers to improve HIV care. We suggest that linkages between formal and informal systems of care be considered across health systems, including governance, human resources, health information and service delivery in order to improve access to HIV services, enable knowledge transfer and strengthen health systems.

Keywords:

• HIV
• continuum of care
• informal providers
• formal providers
• linkages

Acknowledgements

The authors would like to thank Virginia Bond who provided comments on an earlier draft. The study was funded by the Swedish International Development Cooperation Agency through the Africa Regional Program of the International HIV AIDS Alliance, and the UK Department for International Development through the Evidence for Action Research Consortium.

Notes

1. Informal care providers encompass a broad range of people including relatives, peers, community lay health workers, with varying roles and degrees of formal affiliation with the health system.

2. A partnership can be seen as a formally agreed relationship between people or organisations in which they share resources and responsibilities in order to achieve common goals (The Global Fund 2010).