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Background: New Jersey is experiencing challenges due to the changing health care landscape and diminishing resources. The New Jersey Department of Health STD Program conducted a rapid ethnographic assessment to better understand the impact of budget cuts on local STD programs, including the current level of STD service provision, challenges encountered in delivering services, opportunities to collaborate with partners to address gaps, and the current level of STD/HIV service integration in local programs. Data are being used by a state-level workgroup to identify training and technical assistance priorities, develop recommendations, and inform planning.
Methods: Twenty-four semi-structured interviews and observations were conducted with from health department staff in four sites: Camden, Jersey City, Newark, and Paterson. Interviews were carried out by pairs of STD program disease intervention specialists (DIS) who were trained in rapid assessment techniques immediately prior to data collection. Interviewees included local health department Administrative (7), Clinical (4), Field (5), Financial (2), and Management (6) staff. Qualitative interview data were analyzed using NVivo 10.
Results: Significant funding and staffing decreases were reported as major concerns in all sites, and across all job functions. Interviewees reported increased workload and low morale as staff take on additional roles and responsibilities; reduced staff and clinic hours have resulted in longer patient wait times, less time spent counseling patients, and clinic turnaways. At the same time, demand for STD services has remained steady or increased due to the expansion of rapid HIV, and chlamydia testing for men, in some clinics. Interviewees recommended further integration of STD and HIV programs, including cross-training in testing, counseling and partner services. Interviewees also recommended expansion of electronic health records and requested assistance with billing for STD services.
Conclusions: Diminishing resources are negatively impacting local STD program services and staff, even as STD morbidity continues to increase in these communities.