Transcript Slide 1

BEST PRACTICES ON COMMUNITY
STRATEGY: SUPPORT &
SUSTAINABILITY OF HOME AND
COMMUNITY BASED CARE WORK BY
CHWs
Presenter: Mabel Wendo
Mildmay International, Kisumu-Kenya
MILDMAY INTERNATIONAL
• HIV/AIDS NGO based in Kisumu
To improve quality of life of PLWH through
systems strengthening and capacity
building of Ministries of Health, Medical
Training Colleges, and Community Based
Organizations in HIV care and treatment
Background
• Many home & community based care (HCBC) providers
have limited formal training in health care work
• Health facilities often don’t cope with the ever
increasing load of HIV+AIDS cases
• Trained CHWs can reach & provide quality, holistic care
& support to PLWH at household & community levels
• HIV+ clients to receive continuum of treatment, care &
support services that require long-term follow-up which
can be provided best by CHWs at household &
community levels
Why HCBC?
Main aim of providing HCBC is to improve HIV+AIDS care
& management services to PLWH through enhanced
community participation & involvement using existing
MoH Community Units
HOW?
1. By improving the quality of care to HCBC clients (PLWH)
provided by CBO/ CHCs
2. Building & strengthening the capacity of HCBC providers
especially CHWs to be able to provide quality HIV+AIDS
care & support services to PLWH
3. Strengthening Systems of HCBC Participatory Monitoring
& Support Supervision at all levels of service delivery.
The role of CHW’s in HCBC
• Train caregivers at home to provide basic nursing
care, prepare healthy food, prevent the spread of
HIV, and to cope with difficult situations
• Provide emotional support to PLWH & caregivers
• Link PLWH to medical care &other social services &
provide basic nursing care in the home
• Help start PLWH support groups
• Help the family find available resources like food
programs, IGA, and micro-credit
• Create awareness in the community to reduce levels
of stigma
To do their work well, CHWs need skills on…
• Basic hygiene and personal care
• Treating simple OIs
• Communication Skills for transferring knowledge &
skills to care givers & other community members
• Giving emotional support & nutritional information
• Providing of non-clinical FP methods
• Mobilizing the community (e.g., for prevention, to
create support groups for PLWH, to support OVCs)
• Making referrals, follow-up & defaulter tracing
• Keeping records and reporting data
What is the community strategy?
• A community-based mechanism through which
households & communities take an active role in health
& health-related development issues.
• The strategy intends to improve the health status of
Kenyan communities through the initiation &
implementation of health actions at level 1 (community)
by:
– Providing level 1 services for all cohorts
– Building the capacity of the (CHEWs) & (CORPs)
– Strengthening health facility–community linkages
– Strengthening the community to progressively realize
their rights for accessible & quality care and to seek
accountability from facility based health services
The planned levels of care
L6: tertiary hospital
L5: secondary hospital
L4: primary hospital
L3: H/C, Mat. Home
L2: dispensary
L1: community
MI: The Community Strategy
DHMTs-L4
District
HCBC
Coordinators
Health facility(L2 & L3)
Divisional
HCBC
Coordinators
Community
Units (CUs)-L1
Home
CHCs
CHEWs
CHWs
Family Care
Givers
Quality Care to\People Living With HIV (PLWH)
Best practices of community
strategy
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Training of CHWs using a standardized manual
Selection criteria for CHWs available
Equipping family care givers with skills
Linkage and networking with MOH and other ministries
Involvement of local organisations
MOH providing support supervision to CHWs
Treatment adherence
Defaulter tracing
Strengthening access to care for HIV Positive children
Participatory Project/Programme Monitoring &
Evaluation
Best Practices continued
• Strengthening access to care for children
living with HIV
• Regular meeting of all community
members involved
Lessons Learnt in the field
• Community strategy is a good tool to provide
CHW and CORPS with general integrated/holistic
health knowledge & skills
• Community strategy helps in reducing stigma and
discrimination because of the integrated
approach
• Helps in reduction of defaulter rates and
increases access to care
Challenges
• Integration of HCBC in community strategy:
reporting tools not yet harmonized, resulting in
under or double reporting
• Different approaches to trainings by different
partners
• Volunteerism versus payments
• Understaffing in the facilities
• Distance to the health facility
• Poverty
• Child headed households
• Old Care givers (Grand parents)
• People with disability
Way Forward
• Participation through HENNET of pre-testing Community
Strategy reporting tools
• Assist in clarifying training approaches & flag up gaps
with the Ministries of Health
• Lobby for clear strategies for incentives versus
sustainability
• Assist CHW & CHC in creatively developing affordable &
appropriate non-monetary incentives
• Request to HENNET to advocate for strengthening of
community strategy especially to include vulnerable
groups
Conclusion
• Coordination of CHWs & CHEWs in delivering
HCBC within community strategy is a critical
component of the global response to HIV+AIDS.
Together we can make a difference