title: What can volunteer co-providers contribute to health systems? The role of people living with HIV in the Thai paediatric HIV programme.
abstract: In Thailand people living with HIV (PLHIV) have played a major role in shaping policy and practice. They have acted as volunteer co-providers, although their potential in terms of paediatric service provision has seldom been explored from a health systems perspective. We describe the Thai paediatric HIV care system and use both demand- and supply-side perspectives to explore the impact, opportunities and challenges of PLHIV acting as volunteer co-providers. We employed qualitative methods to assess experiences and perceptions and triangulate stakeholder perspectives. Data were collected in Khon Kaen province, in the poorest Northeastern region of Thailand: three focus group discussions and two workshops (total participants n = 31) with co-providers and hospital staff; interviews with ART service-users (n = 35). Nationally, key informant interviews were conducted with policy actors (n = 20). Volunteer co-providers were found to be ideally placed to broker the link between clinic and communities for HIV infected children and played an important part in the vital psychosocial support component of HIV care. As co-providers they were recognized as having multiple roles linking and delivering services in clinics and communities. Clear emerging needs include strengthened coordination and training as well as strategies to support funding. Using motivated volunteers with a shared HIV status as co-providers for specific clinical services can contribute to strengthening health systems in Asia; they are critical players in delivering care (supply side) and being responsive to service-users needs (demand side). Co-providers blur the boundaries between these two spheres. Sustaining and optimising co-providers' contribution to health systems strengthening requires a health systems approach. Our findings help to guide policy makers and service providers on how to balance clinical priorities with psycho-social responsiveness and on how best to integrate the views and experience of volunteers into a holistic model of care.
authors.affiliation: Department of International Public Health, Liverpool School of Tropical Medicine, UK. Electronic address: Olivia.Tulloch@lstmed.ac.uk.
authors.forename: Olivia
authors.initials: O
authors.lastname: Tulloch
authors.affiliation: Department of International Public Health, Liverpool School of Tropical Medicine, UK.
authors.forename: Miriam
authors.initials: M
authors.lastname: Taegtmeyer
authors.affiliation: SEARCH and HIV-NAT, The Thai Red Cross AIDS Research Center, Bangkok, Thailand.
authors.forename: Jintanat
authors.initials: J
authors.lastname: Ananworanich
authors.affiliation: Bureau of AIDS, Tuberculosis and Sexually Transmitted Infections, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand.
authors.forename: Sanchai
authors.initials: S
authors.lastname: Chasombat
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
authors.forename: Pope
authors.initials: P
authors.lastname: Kosalaraksa
authors.affiliation: Department of International Public Health, Liverpool School of Tropical Medicine, UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Theobald
mesh_terms: D000293:Adolescent; D002648:Child; D003695:Delivery of Health Care / Q000379:methods*; D005260:Female; D006078:Government Programs / Q000600:supply & distribution; D015658:HIV Infections / Q000628:therapy*; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D036301:Qualitative Research; D013785:Thailand; D014838:Volunteers / Q000193:education*
keywords: Asia; Co-provider; Health system strengthening; PLHIV volunteer; Paediatric HIV; Task-shifting; Thailand