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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