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Table 3 Key health system, adoption system and broader context barriers to integration of HIV, TB and malaria services into antenatal care

From: Achieving development goals for HIV, tuberculosis and malaria in sub-Saharan Africa through integrated antenatal care: barriers and challenges

Health system characteristics

 Insufficient resources and financial infrastructure

• Weak disease-specific and antenatal care program links

• Weak health systems

• Financing of health services may be required to change to fit integration of previously separate services

 Inadequate physical and technical infrastructure

• Services provided at different locations

• Services not provided on same day

 Ineffective procurement and distribution systems

• Patient drug procurement/administration at different locations

• Inadequate and irregular supplies of essential drugs and interventions

 Inadequate information systems

• Weak monitoring and evaluation systems

 Insufficient human resources

• Staff shortages and overburdened staff

• Frequently reallocated workforce

Adoption system

 Insufficient buy-in from healthcare implementers

Buy in can be affected by:

• Limited human resource capacity, time, training and financing for extra

• Service delivery tasks

• Lack of supervision

• Poor motivation

 Inconsistent leadership and governance

• Inconsistent national policies

• Inconsistent guidelines and training documents

• Poor adherence to guidelines

Broader context

 Patient-centred barriers to service delivery

• Attending multiple clinics on separate occasions/locations

• Time away from work/parenting obligations

• Costly and timely transport options

• Lack of partner support

 Cultural and social barriers

• Fear and stigma, lack of trust in interventions

• Societal attitudes towards HIV, tuberculosis, malaria

 Funding structures

• Historical focus on donor funding to specific diseases

• Siloed and disease-specific funding models

• Complexities of different levels of government funding