Health Facility Staff: Institutional Policies (Tier 1)
It measures whether health facility staff are aware of whether their healthcare facility has written guidelines to protect patients living with HIV from discrimination.
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. Often guidelines are in place, but staff is not aware of them. Hence, this indicator is collected at the level of individual health facility staff, and measures awareness of written guidelines in their own institutions in addition to addressing an institutional factor that helps to reduce HIV stigma and discrimination in healthcare facilities. The existence 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.
Number of health facility staff who reported yes
Number of all health facility staff who answered the statement
Numerator / Denominator
Any form of facility-based surveys of health facility staff. For example, Service Provision Assessments, Quality Assurance Surveys
This indicator is constructed from the response to the following question:
- My health facility has written guidelines to protect patients living with HIV from discrimination. ( yes, no, don’t know)
Every 3-5 years
Measuring the existence of institutional-level facilitators and barriers for providing non-stigmatizing and non-discriminatory care in healthcare settings is critical because it captures whether health facilities offer an environment in which stigma and discrimination are not tolerated and whether policies and practices within the healthcare setting support high-quality care.
While this question captures knowledge by health facility staff of the existence of written guidelines to protect patients living with HIV from stigma and discrimination, which is a necessary first step, it does not provide any information about whether or how well the guidelines are being implemented. Therefore, if resources allow, we recommend collecting indicator 1.1b (Tier 2): I will get in trouble at work if I discriminate against patients living with HIV. This question should be asked before asking about written guidelines, to reduce social desirability bias in the response to the question about existence of written guidelines.
For further information on the methodology and survey instruments, visit http://www.healthpolicyproject.com/index.cfm?ID=publications&get=pubID&p....
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. http://www.healthpolicyproject.com/index.cfm?id=publications&get=pubID&p...
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
http://www.jiasociety.org/index.php/jias/article/view/18718 | http://dx.doi.org/10.7448/IAS.16.3.18718