a b s t r a c t
In Thailand people living with HIV (PLHIV) have played a major role in shaping policy and practice. They
have acted as volunteer co-providers, although their potential in terms of paediatric service provision has
seldom been explored from a health systems perspective. We describe the Thai paediatric HIV care
system and use both demand- and supply-side perspectives to explore the impact, opportunities and
challenges of PLHIV acting as volunteer co-providers.
We employed qualitative methods to assess experiences and perceptions and triangulate stakeholder
perspectives. Data were collected in Khon Kaen province, in the poorest Northeastern region of Thailand:
three focus group discussions and two workshops (total participants n ¼ 31) with co-providers and
hospital staff; interviews with ART service-users (n ¼ 35). Nationally, key informant interviews were
conducted with policy actors (n ¼ 20).
Volunteer co-providers were found to be ideally placed to broker the link between clinic and communities
for HIV infected children and played an important part in the vital psychosocial support
component of HIV care. As co-providers they were recognized as having multiple roles linking and
delivering services in clinics and communities. Clear emerging needs include strengthened coordination
and training as well as strategies to support funding.
Using motivated volunteers with a shared HIV status as co-providers for specific clinical services can
contribute to strengthening health systems in Asia; they are critical players in delivering care (supply
side) and being responsive to service-users needs (demand side). Co-providers blur the boundaries
between these two spheres. Sustaining and optimising co-providers' contribution to health systems
strengthening requires a health systems approach. Our findings help to guide policy makers and service
providers on how to balance clinical priorities with psycho-social responsiveness and on how best to
integrate the views and experience of volunteers into a holistic model of care.
© 2014 Elsevier Ltd. All rights reserved.