Upload
elda
View
58
Download
2
Embed Size (px)
DESCRIPTION
Community Mobilization & Expanding Community-based Service Delivery. Bactrin Killingo MD ITPC. Setting the Scene . What’s happening out there? . Community Participation … Bottom up approach … the power & contribution of the beneficiaries of care…. Community-driven development (CDD) - PowerPoint PPT Presentation
Citation preview
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