Transcript Slide 1

The Importance of Community Engagement in the
Global Plan Towards the Elimination of New
Infections and Keeping their Mothers Alive
Community Engagement Working Group
Angelina Namiba, Positively UK
31 October 2012
Overview
I. Who is the “Community”?
II. What is Community Engagement?
III. Why is Community Engagement Important?
I.
Examples of Successful Community Engagement
Initiatives around Prevention of Vertical Transmission
IV. How can communities be supported?
V. Questions
1
Who is the “Community”?
Communities are groups of people linked by common
ties (e.g. cultural identity, geographic place).
Within the HIV response these communities
include:
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networks of people living with HIV,
community leaders, service users,
faith-based organizations,
advocacy groups
men, women, boys and girls
actual communities – towns, villages, groups of people
living together
2 What is “Community Engagement”?
Community engagement is a process by which
the community is engaged to:
 work collaboratively with national and local health
authorities, facility and community based medical
service providers, legislators, advocacy groups,
donors and others engaged in efforts to develop,
implement and evaluate Global Plan related care;
 empower women and their communities to access
health care and hold those who provide it
accountable.
Why is Community
Engagement
IMPORTANT?
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Community Engagement is important
because it:
 Increases demand for services
 Improves client retention
 Improves uptake of and adherence to interventions that will
achieve Global Plan goals and objectives.
 Addresses HRH/HSS issues by engaging a massive potential
workforce by enlisting communities in the provision of care;
 Builds strong linkages between health facilities and
communities
 Brings men and families into comprehensive PVT care and
ensure that they also get the services they need.
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How Can our Communities Engage in
this Work to Achieve Rapid Scale-up?
Communities can:
 Improve the supply and quality of services
 Increase the uptake of services, including ARV
adherence and facility delivery and follow-up
 Create an enabling environment
Improve supply & quality of services
Communities can improve the supply and quality of
services by:
 Serving as extension workers and expanding and
supporting front-line health care workers e.g. community
based distribution of family planning,
 Creating links between community- and faith-based
organizations and facility-based services,
 Monitoring and holding governments accountable to
provide services that suit the needs of women, men and
children.
 Having peer educators and mentor mothers in health
facilities provide education and support where there are
too few doctors and nurses (HSS/HRH/Task shifting and
sharing)
 Having community workers reach into communities
 Holding health facilities as well as governments
accountable.
Mothers2Mothers
Engaging women living with HIV as mentor mothers
 714 sites in nine countries
 Mothers living with HIV are recruited, salaried, trained, supervised,
and engage in career development
 From Pregnancy to Baby and Beyond Project , London
 Results:
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Increased ARV uptake: In Kenya, rates of ARV uptake among women who
interacted with mentor mothers at least 4 times was 97% compared with 62%
among women with no interaction
Increased postpartum CD4 testing
Increased treatment initiation
Increased HIV disclosure
Increased infant testing
From Pregnancy to Baby and Beyond Project , London
Community Engagement in Monitoring Services
In Uganda, 50 communities were informed of their
rights and issued with “report cards”
 Communities encouraged to identify solutions, develop
remedial action plans, and implement and monitor them
 Meetings were held with community members and health
facility staff to create a jointly-owned action plan
 Approximately 55,000 households were reached
 Results (in 1 year):
 Increase in antenatal visits, facility deliveries and family planning visits
 Increase in infant weight for age
 33% reduction in deaths among children under 5
Increase uptake of services
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Communities can increase the uptake of services
(including ARV adherence and facility delivery and
follow-up) by:
Participating in campaigns for behavior change and
reduction of discrimination,
Providing peer support,
Maximizing the use of community assets, resources, and
Creating demand through treatment literacy and
awareness of availability of services
Supporting community led health promotion campaigns to
create demand and increase uptake
Involving Men in Zambia
The Catholic Medical Mission Board developed a
communication strategy to promote male involvement in
reducing pediatric HIV
 Engaged traditional leaders as allies and champions of
prevention of vertical transmission (PVT)
 Identified male attitudes/practices that negatively impact
women’s access to services and developed a community
education strategy
 Results
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Within 5 months, 65% of 2,261 men in the program tested for HIV (11% baseline)
4x increase in same day counseling and testing of pregnant couples
Antenatal clinic clients’ acceptance of HIV counseling and testing rose of 95%
(60% baseline)
Acceptance rates for ARV prophylaxis or treatment among women who
tested positive rose to 70% (40% baseline)
Peer Extension Workers in Uganda
In the Nyimbwa Multipurpose Self-Help Group, people
living with HIV are selected as Network Support
Agents (NSA)
 Trained in ARV adherence, nutrition, pregnancy and HIV,
disclosure, and counseling
 Spend 2 days/week in a health clinic and 3 days in the
community to mobilize people to use clinic-based services
and support services
 Results
 Decreasing stigma and discrimination in the community and in hospitals
 In one of the 40 districts where NSA operated, the number of people
accessing PVT services increased from 1,294 to 15,892
Create an Enabling Environment
Communities can create an enabling
environment by:
 Advocating for scale-up and the right to sexual and
reproductive health,
 Promoting community engagement in policies and strategies.
 Addressing HIV related stigma and discrimination and gender
inequalities
 Participating in technical working groups
Community Mobilization in South Africa
Treatment Action Campaign (TAC) pressured
the Government to roll out ARVs for PVT
 Advocacy included human rights education,
treatment literacy, public demonstrations and
litigation
 In-service trainings of health clinic staff and clients
 Trace contracts and measure adherence
 Media and door-to-door campaigns
How can communities be supported?
A sustained process that enables community
members to participate in program design,
implementation and monitoring
This in turn requires:
 Financial and technical support and investment to build
skills and to coordinate and implement programs
 Meaningful involvement of networks of people living with
HIV, the people who are most committed to having
healthy, HIV-free babies
 Training and on-going supervision
Questions?
We are ready and able to help.
Email:
Georgina Caswell ([email protected])
Amy Medley ([email protected])