1

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

2

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.

3

Community dialogue session to kick start MHCT

4

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.

5

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.

6

Methodology: A ten-point intervention strategy was used during the

LMS-ACT project

(project duration: nine months)

Management Sciences for Health (MSH)

7

A FRAMEWORK FO FUNCTIONAL SERVICE DELIVERY

POINTS

BC

F G

8

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

9

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

10

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

11

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.

12

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.

13

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.”

14

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”.

15

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”.

16

Management Sciences for Health Facility Summary

November 2008 – July 2009

Data is cumulative from each facility inception till July 2009

17

Management Sciences for Health Facility Summary

November 2008 – July 2009

Data is cumulative for each facility from their

respective inceptions till July 2009

18

19

20

� 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

21

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

22

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)

23

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.

24