02 Sahara Presentation Ogunyemi Foluke Adetola
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Transcript of 02 Sahara Presentation Ogunyemi Foluke Adetola
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Title: Applying the Functional Service Delivery Point framework to AIDS care, treatment and support services in low prevalence districts: Experiences from north western Nigeria
Author: Ogunyemi Foluke Adetola
Co Authors: Uwem Udoh and Umar Mohammed
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Aim:
Creating individual awareness of personal HIV sero-status and
responsibility for individual and family health.
Creating a demand and supply pool for HIV/AIDS treatment, care and
support in low prevalence districts.
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Community dialogue session to kick start MHCT
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Setting for the operational and programmatic
activities
Kebbi State is located in the North-western part of Nigeria, with its
capital at Birnin Kebbi The State has a total population of 5,837,989
people as projected from the 2005 census, within 21 Local
Government areas. These LGAs are Aleiro, Arewa, Augie, Argungu,
Bagudo, Birnin-Kebbi, Bunza, Dandi, Danko-wasagu, Fakai, Gwandu,
Jega, Kalgo, Koko-Besse, Maiyama, Ngaski, Sakaba, Shanga, Suru,
Yauri and Zuru in four Emirates namely: Gwandu, Yauri, Zuru and
Argungu. The state has Sudan and Sahel-savannah. The southern part
is generally rocky with River Niger traversing the state from Benin
republic up to Ngaski LGA. The northern part of the state is sandy
with river Rima passing through Argungu to Bagudo LGA where it
empties into river Niger.
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Agriculture is the main occupation of the people especially in rural
areas, Crops produced are mainly grains, animals rearing and fishing
are also common. The state has four major tribes, which include:
Hausa, Fulani, Dakarkari and Gungawa. Islam is the dominant religion
of the people. There are 225 political wards, 3000 settlements and
1036 hard to reach settlements in the 21 local Governments in the
State.
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Methodology: A ten-point intervention strategy was used during the
LMS-ACT project
(project duration: nine months)
Management Sciences for Health (MSH)
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A FRAMEWORK FO FUNCTIONAL SERVICE DELIVERY
POINTS
BC
F G
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FRAMEWORK LEGEND
A= local participation to generate ownership of and demand for
services
B= Clients are able to act on their needs
C/D= Clients demand and providers offer quality services
E= Providers performance meets accepted standards
F= Organizational program management strengthens providers
performance
A&B = Socio cultural Environment
F&G = Policy Environment
C= Client
D= Provider
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Components of the framework
Supply Side
1. A supportive policy environment
2. Health management support required by providers
3. Supply of health services
Demand Side
1. Community participation and support
2. Supportive socio cultural environment
3. Demand for and use of health services
A service delivery point becomes functional when everything is in place
creating an enabling environment
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Methodology
Management Sciences for Health (MSH)
•Selecting rural districts with primary/secondary health care centers without service providers for HIV/AIDS diagnosis, care and treatment as service delivery sites.
•Proper training of workforce in the healthcare centers designated as service delivery points and provision of technical assistance through specialists.
•Supply of equipment and supplies for comprehensive HIV/AIDS care and treatment.
•Advocacy, sensitization and collaboration with community leaders and stakeholders to generate demand for HIV/AIDS services by the populace.
•Demand and Supply chain created when enlightened populace seek counseling and testing
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Methodology continued
Management Sciences for Health (MSH)
•Provider initiated testing and counseling (PITC) for all visitors to health facilities. (Patients and caregivers).
•Mobile HCT outreaches to MARPS zones
•Enrollment and continuous supply of free treatment and basic care kits to PLWHA
•Formation of client support groups to follow up clients and ensure community care and support
•Enrollment of clients’ children and wards as vulnerable so as to benefit from basic HIV: OVC services.
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Results
Management Sciences for Health (MSH)
•12,400 persons demand and receive PITC services between November and July 2009
•Point prevalence of HIV at time of entry into care after receiving PITC services was 3.35%
•Of the 415 positive cases demographics reveal 67% as females, 72% as subsistence farmers (small scale pastoralists, crop farmers and fishermen) with less than 5% of clients having formal education.
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SUCCESSES OF FAMILY-CENTERED APPROACH FOR
HCT SERVICES
Provision of HCT services to family of twenty seven persons , Six
tested Positive and gradual enrollment into care is on-going (3
persons have been enrolled)Comment from family member
“ I must thank MSH for bringing succor to my family, when my
mother was tested positive at the ANC, my father vehemently rejected
the result and denied her access to care. when finally she had to
return to the hospital months later the baby was positive. The MSH
team of counselors and specialists were carefully persistent in urging
that all members of our family get to know our status. Despite being a
teenager, the continuous counseling gave me courage to test and
even volunteer to be trained as HCT counselor, after which I convinced
my father to allow every member of my family get tested. Although
my father, his four wives and last child tested positive I am aware of
ART care that will help them stay healthy and I can counsel them on
positive living. Thanks to MSH for this opportunity and for bringing
hope to us in this village.”
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Success story from PITC volunteer
“ Our husband died three years ago, I had no idea the illness was
HIV/AIDS and I had no knowledge about the disease. before his death
i was not allowed to work despite my tertiary level education due to
cultural/religious reasons. I started falling ill often and my children
were suffering due to poverty, I was counseled at the government
hospital on HCT and I accepted to test and be really sure of what was
wrong with me. MSH has been wonderful and faithful, not only am I
enjoying the free ART care, I was trained as a PITC volunteer and I
now have a job offering HCT to as many people visiting the hospital
daily which means I have moved from my previous poverty level to
earning some allowance. I also joined the support group for
psychosocial support and guess what…..I found love with another
client and we got married two weeks ago! Thanks to God for MSH, my
life has turned around for good”.
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Provision of HCT services to family of fourteen persons,
three tested positive and have been enrolled into care.
Comment from Head of household.
“ when as a police officer I tested positive in 2002 on duty in Lagos, I
thought my life was over especially as I couldn't access ART so I was
seeking herbal and spiritual healing. I assumed the subsequent
redeployment to my home state (Kebbi) was a stigmatizing move, but
I was able to enroll for ART in Sokoto when GHAIN came, now MSH
has come to my village for almost a year and things have been
wonderful for me and my family. I was counseled to disclose my status
to my wives and also bring them for HCT, two of my three wives are
Positive and have been enrolled for the free care, my last wife and all
my children are negative and we receive counsel continuously on
positive living to maintain our status. Recently MSH trained me when
I volunteered to be an HCT counselor and am happy to be able to
make live better for other people through HCT”.
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Management Sciences for Health Facility Summary
November 2008 – July 2009
Data is cumulative from each facility inception till July 2009
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Management Sciences for Health Facility Summary
November 2008 – July 2009
Data is cumulative for each facility from their
respective inceptions till July 2009
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� This new approach for universal access to HCT
encourages community participation to generate
demand for HIV/AIDS care, treatment and support
services.
� Efficient in rural areas to promote service delivery
without interfering with cultural and religious norms.
� It creates a high level of awareness for prevention,
promotes positive living but requires high level
advocacy and cooperation of all stakeholders to make
it fully functional
Management Sciences for Health (MSH)
Conclusion
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NEXT STEPS
Intensify community participation through monthly town hall
meetings to promote male involvement in PMTCT and MCH
Institute technical working groups for health in each rural district
headed by the Local Action Committee on HIV/AIDS
Hold focused group discussions and Key informant interviews with
stakeholders and gate keepers on a quarterly basis to monitor
progress of work done
Increased OVC service delivery and meaningful involvement of
PLWHAs as community services volunteers and OVC service
volunteers
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Acknowledgement:
Management Sciences for Health (MSH)
United States Agency for International Development (USAID)
General Hospitals in Koko, Jega and Argungu L.G.A (Kebbi state)
Management Sciences for Health (MSH)
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References and Appendix
References: The Manager, Vol. 11 N0. 22 Pages 1-20 and MSH Kebbi office data base
Appendix:
PITC—Provider Initiated Counseling and Testing
PMTCT- Preventing mother to child transmission of HIV
MCH- Maternal and child health
MHCT---- Mobile HIV Counseling and Testing
FSDP—Functional Service Delivery Point
LMS-ACT—Leadership, Management and Sustainability AIDS
care and treatment.
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