All effective treatments have some common elements, such as supportive relationships and respect for ethics. However, the factors that affect decisions about treatments can be very different. These include technical, financial and social factors.
Technical factors. Treatments can differ in the training, equipment and facilities needed to provide them. For example, in a home-care setting, these would vary greatly for paracetamol compared with antiretroviral drugs.
Key technical questions to consider:
• How much training is required to provide the treatment?
• Can the treatment be provided only by a qualified health worker?
• Are special equipment, facilities or services required to provide the treatment?
• Is it easy for the person receiving the treatment to use it?
• Is the treatment effective only if it is taken in combination with others?
• Does the person using the treatment need the help of a skilled worker to use it?
• Would you start the treatment without being sure that you have enough supplies for the full course?
• Can the treatment be delivered easily to a large number of people?
Financial factors. The costs of treatments vary greatly. It is important to consider whether the costs can be met for the whole time that a treatment should be given. If a treatment is not used for the correct time, people can become ill again or become resistant to certain drugs, making further treatment more difficult or even impossible. It is important to consider how much it will cost for someone to access the treatment for as long as they need it.
Key financial questions to consider:
• What is the actual cost for the full course of the treatment?
• Are there other costs involved in the treatment (such as travel, food or the necessary laboratory tests)?
• What are the costs involved in delivering the treatment to a sizeable number of people?
• Would you start providing the treatment if you did not have enough money to pay for the full course?
Social factors. Social factors play an important role in accessing treatment. For example, if those attending an HIV/AIDS clinic are stigmatized, people may not go there for treatment. Communities view different treatments in different ways. It may be acceptable for people to openly use paracetamol but stigmatizing to use TB drugs. So, even if the treatment is available, people may be afraid to access it.
Key social questions to consider:
• How does the community view the treatment?
• What are the social implications for someone who goes for/uses the treatment?
• Is the treatment sensitive to the person seeking treatment? For example, can a sex worker access the treatment?
• Do cultural beliefs or practices have an impact on the treatment?
Participatory group activity
To assess different treatments in terms of their technical, financial and social factors.
1. Explain the aim of the activity.
2. Divide the participants into three groups. Allocate a type of treatment to each group, for example:
Group 1: a drug for TB prophylaxis, such as isoniazid (INH);
Group 2: an antiretroviral drug, such as zidovudine (AZT);
Group 3: a drug for pain relief, such as paracetamol.
3. Give each group a copy of a treatment assessment sheet (see example on page 53 at the end of this chapter). Ask them to use it to assess the technical, financial and social factors that affect their type of treatment.
4. Bring everybody back together and ask the groups to share their results. Encourage the participants to ask each other questions and to make comments.
5. Facilitate a group discussion about what has been learned from the activity, based upon questions such as:
• To what extent do the factors vary for the different treatments?
• How would the different factors affect the decisions that an NGO/CBO might make about what type of treatment to provide?
• Which factors could be easily changed? Which could not?
• Select treatments that participants are familiar with, so that they can carry out a thorough analysis.
• Encourage participants to discuss the answers to the questions in the treatment assessment sheet and to reach consensus within their group, rather than simply ticking the boxes.
• Encourage the participants to identify other key questions about technical, financial and social factors affecting treatment.
At a skills-building workshop, NGO/CBO participants used a treatment assessment sheet to analyse the technical, financial and social factors affecting three types of HIV/AIDS-related treatment - paracetamol (a drug for pain relief), isoniazid (a drug for TB prophylaxis) and zidovudine (an antiretroviral drug). The results of the analysis of technical factors for paracetamol, for example, are shown in the box below.
Treatment Assessment Sheet - Paracetamol: technical factors
Afterwards, the facilitator led a group discussion about what had been learned from the activity. For example, participants agreed that NGOs/CBOs need to make strategic decisions about balancing cheap general treatments (such as paracetamol) with expensive HIV/AIDS-specific ones (such as antiretroviral drugs).
Reference: Adapted from a workshop on access to HIV-related treatment, Khmer HIV/AIDS NGO Alliance and the International HIV/AIDS Alliance, Cambodia, May 2001.