Community Mobilization & Expanding Community-based Service Delivery

Bactrin Killingo MDITPC

IAS 18th June 2011

Rome Italy

Setting the Scene

What’s happening out there?

Community Participation …

Bottom up approach … the

power & contrib

ution of the

beneficiaries of care…

Community-driven development (CDD)

An approach that aims to give control over

planning decisions and resources to community

groups … operat(ing) on the principles of local

empowerment, participatory governance, demand-

responsiveness, administrative autonomy, greater

downward accountability, and enhanced local

capacity. (World Bank)

Community Systems

Community-led structures and mechanisms used by

communities through which community members and

community based organisations and groups interact,

coordinate and deliver their responses to the challenges

and needs affecting their communities.

Community Response…social dynamics &

relationships

Awareness Testing Diagnosis Treatment Initiation

Adherence & Follow

upClinical

Outcomes

Opportunities to Test

Partner Communication

& Approval Family Support & Disclosure

Delivery in a Clinic

Self Efficacy

Social Capital & Networks

Perception of Risk

Accurate Local Understanding

Transport & Time Costs

Motivation vs Fear of Results

Fear of abandonment &

Violence

Perception of Service Quality

STIGMA

Depression & Ill Health

HIV Treatment Cascade

Borrowed from Joanna Busza – IAS 2011

POC Comprehensive

Testing & Treating

POC Community Treatment

Groups

PPTCT Cascade Of 100 HIV+ Mothers entering the Program

Those who attended ANC

Clinic 92%

Those who Counseled &

Tested for HIV, CD4 75%

Those who get ARVs (Pre &

Postnatal) 50%

34

68

92

Source: CIFF analysis based on presentation by P Barker at WHO PMTCT consultation meeting Nov 2008

Community Mobilization

The Why, What Who..

Community MobilizationWhy & For What?

Increase Demand for HIV Treatment & Prevention Services – Know HIV Status– Treatment literate persons – Timely referrals– Regular community led Monitoring & Follow up

Increase Supply for HIV Treatment & Prevention Services – Additional/alternative Human resource – Advocacy for policy change – Advocacy for change in programming & facility based service

delivery

Beneficiary of CareIndividual

Family

Organized PLHIV

Groups

Private Entities

Cultural Entities

Admin Bodies

•Local Admin•MPs•Civic Leaders

•Support Groups•CBOs •Networks

•NGOs (For/Not For Profit)•Businesses

•Religious Orgs•Council of Elders

Who should be Mobilized?

Expanding Community Based Service Delivery

The Possibilities…

Why Community Led/Based ServicesKey Unique ContributionCommunities have the understanding, experience & skill Access Community service entities have reach to compliment facility based health service provision Ownership Of the people, By the people for the people Acceptance Community led services are likely to have more takers

Community consciousness of their role in service delivery • Community reorganizing to be in tune with new paradigm (Tx

2.0)– Treatment literacy programes – Point of Care community led linked services

• Testing; mobile, house to house etc • Treatment access information • Treatment referral• Treatment care groups – Mozambique example

• Country Policy review to adopt & implement the CSS framework

• Resourcing community led service delivery

How to Expand Community Based Services

Figure 2: Community action and results for health

Activities/services for communities

(Community) Systems

develop & manage

that they use to deliver

Health ActorsCommunity

Actors

Outputs

Health outcomes

Other outcomes

Impacts on health

Resulting in:

which in turn contribute to

that lead to

Source: GFATM CSS Framework 2010

Table 1. HIV services and activities that CBOs are uniquely placed to deliverTreatment Prevention Advocacy

Adherence supportTesting and counsellingTreatment literacy Linkage to care/support servicesLinkages to harm reduction servicesManagement of health and psycho-social needs following testingDisclosure supportTreatment delivery (a treatment extension role for community organizations)Case managementNutritional support

Prevention of vertical transmission Harm reduction services (syringe exchange, opioid substitution therapy [OST], etc.)Sexuality educationSexual and reproductive health and rights awarenessCondom distributionPrEP (pre-exposure prophylaxis) education Education on TB infection controlContact tracing/partner notification supportClient negotiation, collectivization, peer outreach skills for sex workersPromotion of male circumcisionPost-exposure prophylaxis (PEP) for sexual assault survivors

Monitoring and accountability (health systems, government responses, rights abuses, quality of services)Quality assurance of health servicesAnti-stigma, anti- discrimination, and decriminalization efforts(legal support, law reform, lobbying) Policy analysis around access to and development of essential medicinesEnsuring the meaningful involvement of people living with AIDS in policy and programme development

• Community consciousness of role in service delivery Community reorganizing to be in tune with new paradigm (Tx 2.0)– Treatment literacy programes – Point of Care community led linked services

• Testing, counseling, disclosure support; mobile, house to house etc • Treatment access information • Treatment referral• Case management through Treatment care groups – MSF Mozambique &

AMPATH Kenya Models* • Psycho-social & Nutritional support

• Country Policy review to adopt & implement the CSS framework • Resourcing community led service delivery

How to Expand Community Based Services

*Distribution of Antiretroviral Treatment through Self Forming Groups of Patients in Tete Province, Mozambique (Decroo 2011)‐*Wools-Kaloustian KK, Sidle JE, Selke HM, Vedanthan R, Kemboi EK, Boit LJ, Jebet VT, Carroll AE, Tierney WM, Kimaiyo S. A model for extending antiretroviral care beyond the rural health center. J Int AIDS Soc. 2009 Sep; 12(1):22

•Individual/Family Centered •Voluntary •Community led

Comprehensive Prevention PackagePPTCT

Optimal Treatment

Easy to useAffordableUninterrupted

Refer

Educate

InitiationPOC Monitoring Support System(s)

CommunityExpanded Services

Test

TreatPrevent

How to Expand Community Based Services

• Community consciousness of role in service delivery • Community reorganizing to be in tune with new paradigm (Tx

2.0)– Treatment literacy programes – Point of Care community led linked services

• Testing; mobile, house to house etc • Treatment access information • Treatment referral• Treatment care groups – Mozambique example

Country Policy review to adopt & implement the CSS framework Resourcing community led service delivery – Local & Global Innovative Mechanisms & Frameworks

CommunityExpanded Services

Test

TreatPrevent

•Individual/Family Centered •Voluntary •Community led

Comprehensive Prevention PackagePTCT/PMTCT

Optimal Treatment

Easy to useAffordableUninterrupted

Refer

Educate •Leadership

Stewardship•Supportive Policy & Operational Plans•Resources • Man• Money• Moment

InitiationPOC Monitoring Support System(s)

Ahsante Sana