Table 3 Health system resources and capacity related facilitators and barriers to UTT policy and same-day ART initiation implementation

Facilitators

 Existing minimum capacity for immediate policy assimilation

“…much as [SDI] it’s not a new service that we are implementing, but if you’re going to do that [implementing SDI], even at the level of the clinician, that time that the clinician takes to make a proper initiation to the patient and the fact that the resources were never altered.”—PN

 Flexible healthcare providers conditions

“So, with space issues, I think there was a time when we used to do that…when we used to use the emergency room and then you are busy with a client and then an emergency comes in and you have to go, where do you go?”—PN

“Sometime I would have to vacate my office, and say okay finish whatever and then I’m just…you know…roaming around the clinic”—PN

 Technical support partner organisation

“So, they were like, no we don’t have anything in black and white that covers us. But, fortunately [because of the NGO support partner], we had something. They gave us something and referred us to the UTT policy and then they gave us the flow chart, just to guide us to that if patients do this, at least we’ve got the flow chart…”—PN

Barriers

 Lack of provider implementation readiness

“…what I noticed especially with the nurses at our clinic is that they were also resistant to the very UTT because it was not implemented like when NIMART implemented, people went for training, you know, expensive training. But with UTT, just a memo came and said from now on you can do this, and you don’t have to wait for this, and you don’t have to wait for that.”—PN

 Extreme human resources and infrastructural constraints

“Because our clinic when it was formed, or built or whatever…I don’t know exactly the history but it wasn’t for all the services. Hence…It’s a very small clinic, and the service was just for family planning, EPI and but then it started increasing service…and then in June 2016 we started for the first to actually give treatment to HIV positive clients”—PN

“[…] the fact that the resources were never altered, the very same clinicians that were doing other things is expected to do that. Now you are seated with the clinician and that counsellor who are compromised in terms of the quality and standard of care that they can provide, but expected on the other hand, to be implementing the policy itself”—PN

“Hence when we started I mentioned the duties of NGOs…how do they come…how do you say I’m going to support this person…how are you going to? Firstly, the infrastructure is absolutely wrong. You don’t even fit in there [physically], human resource-wise you can’t squeeze somebody there but you say that I’m going to support these people.”—PN