PRESENTATION AND ANALYSIS OF THE MAIN FINDINGS
4.3 THE RESULTS OF THE STUDY
4.3.2 Antecedents for establishing a CoP
4.3.3.1 The National Health Imperatives
130 4.3.3 The context of establishing communities of practice
Defined by Strauss and Corbin (1990), the context refers to a particular set of conditions within which the researcher constructs action and interactional strategies to manage, carry out and respond to the specific phenomenon. In the context of this study a set of conditions which emerged included (i) the national health priorities; and (ii) national frameworks and policy documents. These emerged due to the dynamic and changing nature of HIV/Aids care and management which stemmed from this set of conditions and grounded the need for the development of Communities of Practice to support users (namely nurse practitioners) to cope with the dynamic nature of these clinical guidelines which underpin HIV/Aids care, and to create a platform wherein the objective of the national health priorities and policy documents can be achieved.
131 Reflections from the participants resonated with the transforming climate of health care, and they recognized the need to address priority areas of HIV/Aids, such as reducing the transmission rate of HIV/Aids of mother to child transmission to below 7%. Participants elaborated that it is crucial to have a space where they are able to unpack policies and directives that underpin their practice, thus equipping them with information so as to address the imperatives of the guidelines, such as reducing maternal to child transmission of HIV, in keeping with global directives such as the Millennium Development Goals (MDGs); as shown in one participant’s reflection:
“…you see there are many changes now with HIV care…like we just heard from the district coordinator for PMTCT that our goal in keeping with the MDGs with to reduce child transmission to less than 7%...that is a huge challenge, because we know that we have such high rates…so something is needed…where one can come and get the necessary information about this policies so we can work towards them…” (Urban FGD participant 3)
Participants acknowledged that district health officers were responsible for setting benchmarks for HIV/Aids care and management and performed functions of monitoring and evaluation to ensure that international guidelines were being adhered to. Participants identified some tasks and activities that were part of the HIV/Aids nursing care which were underpinned by the MDG, such as assessing an infant at 6 weeks for viral load (PCR) and promoting safe infant feeding choices to prevent mix feeding and transmission, However, participants highlighted the need for a platform to address the MDGs to help them attain a better working knowledge of the policy in terms of the various MDG goals, specifically goals 4,5 and 6, which they considered crucial to their discipline of maternal and child health and HIV/Aids care. The following extracts highlight the evidence from the data.
“…even the PMTCT policy we are using...it comes from this MDGs...this means that tasks such as taking the baby’s PCR level at 6 weeks…these are all being guided by the MDGs and to reduce the transmission rate to below 7%...but a lot of our nurses we unaware of this… there is no place where these are discussed…” (Urban FGD participant 6)
132
“…when the people from the district health office come…they are checking to see if we are complying with the standards of the MDGs…to ensure quality in the hospital…so the MDG we keep hearing this about such goals like goals 4..5 and I think goal 6…so we can see it is something important to understand…but many of us don’t even know what they are…” (Rural FGD participant 8)
The HIV/Aids and STI National Strategic Plan 2007-2011. Participants also noted that that the
HIV/Aids and STI National Strategic Plan for 2007-2011(referred to as the NSP) were national directives that that champion change for improving interventions and outcomes in curbing the spread of HIV/Aids. Participants recognized that the role of the NSP was similar to the MDGs, and that all their efforts in their nursing practice were aligned towards addressing the imperatives outlined in this document. The selected extracts below illustrate this.
“…I know we have this NSP…it is also something that guides our practice…to assist us with this battle of HIV/Aids and especially with PMTCT program…” (Urban FGD participant 4)
“…sometimes the managers tell us of some policies that we are using for our interventions…and they talk of this NSP…that is a national plan for our country of where we should be in five years…like the MDGs” (Rural FGD participant 7)
However, it emerged from the data that while participants recognized the aim of this national directive in aligning health care efforts towards reducing and managing the spread of HIV/Aids at a macro-level, at a micro-level, they were unable to relate the relevance of its directives to the functions and activities in their work -setting.Participants also revealed that more user-friendly versions of the document and similar policies, such as the PMTCT policy, would make them easier to understand and, thus, more transferable and usable for their practice. They believed that this could be achieved within the envisioned structure of the CoP.
“…this NSP is important for our practice…but like the MDGs very little is known about it…we hear the managers use these terms of NSP or MDG… goals 4,5,6 but I am yet to know what it means for me as a midwife in the labour ward…” (Urban FGD participant 6)
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“…we have no direction on these policies…we don’t even know how to start to read or make sense out of these…like the NSP…I know it is there to guide our practice...but some of use we have never even seen this book or know how to use it in our practice...” (Rural FGD participant 5)