Health Facility Staff: Enforcement of Institutional Policies (Tier 2)

Export Indicator

Percent of health facility staff who report that they will get into trouble at work if they discriminate against patients living with HIV.
What it measures

It measures whether health facility staff perceives that there are negative consequences for staff that discriminate against patients living with HIV in their healthcare setting.


One of the key actionable drivers of reducing stigma and discrimination in health facilities is provision of a health facility environment that supports staff to provide non-stigmatizing and discriminatory care. A critical first step in creating such a supportive environment is the presence of written guidelines to protect patients living with HIV from discrimination. A second step, critical for implementation, is that all facility staff know of the existence of the guidelines, as measured in Tier 1 indicator, 1.1a. The third step is enforcement of the guidelines. Therefore, this indicator measures enforcement of the guidelines, at the level of individual health facility staff, by asking staff if they think they will get into trouble if they discriminate against patients living with HIV. This indicator addresses an important institutional factor that helps to reduce HIV stigma and discrimination in a healthcare facility. The enforcement of written (formalized) guidelines that protect patients living with HIV from stigma and discrimination provides information about whether healthcare settings are working to create a safe environment for their patients. This indicator is a facility-level indicator.


Number of health facility staff who reported yes


All health facility staff who answered the statement


Numerator / Denominator

Method of measurement

Any form of facility–based surveys of health facility staff. For example, Service Provision Assessments or Quality Assurance Surveys

This indicator is constructed from the response to the following question:

  • I will get in trouble at work if I discriminate against patients living with HIV. ( yes, no, don’t know)
Measurement frequency


Every 3-5 years

Strengths and weaknesses

Measuring staff perception of the enforcement of written guidelines and whether there will be any consequences for not adhering to them, captures whether health facilities are creating an environment in which stigma and discrimination are not tolerated and whether policies and practices within the healthcare setting support high-quality care.

This indicator should be asked about before asking about written guidelines, to reduce social desirability bias by prompting respondents in the response to the question about existence of written guidelines.

Further information

For further information on the methodology and survey instruments, visit

Jain, A., and L. Nyblade. 2012. “Scaling Up Policies, Interventions, and Measurement for Stigma-Free HIV Prevention, Care, and Treatment Services.” Working Paper #3. Washington, DC: Futures Group, Health Policy Project.

Nyblade, L., Stangl, A., Weiss, E., & Ashburn, K. (2009). Combating HIV stigma in health care settings: what works?. Journal of the International AIDS Society,12(1), 15.

Nyblade, L. Jain, A. et al. Journal of the International AIDS Society 2013, 16(Suppl 2):18718 |