Community Mobilization & Expanding Community-based Service Delivery

1. Community Mobilization & Expanding Community-based Service Delivery Bactrin Killingo MD ITPC IAS 18th June 2011 Rome Italy

2. Setting the Scene What’s happening out there?

3. Community Participation …Bottom up approach … the power & contribution of the beneficiaries of care… Community-driven development (CDD) An approachthat 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 Response …social dynamics & relationships 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.

4. HIV Treatment Cascade Delivery in a Clinic Social Capital & Networks Partner Communication & Approval Opportunities to Test Family Support & Disclosure Self Efficacy Transport & Time Costs Fear of abandonment & Violence Perception of Service Quality Accurate Local Understanding Depression & Ill Health Motivation vs Fear of Results Perception of Risk STIGMA Borrowed from Joanna Busza – IAS 2011

5. POC Comprehensive Testing & Treating

6. POC Community Treatment Groups

7. PPTCT Cascade Of 100 HIV+ Mothers entering the Program Those who attended ANC Clinic 92% 92 Those who Counseled & Tested for HIV, CD4 75% 68 Those who get ARVs (Pre & Postnatal) 50% 34 Source: CIFF analysis based on presentation by P Barker at WHO PMTCT consultation meeting Nov 2008

8. Community Mobilization The Why, What Who..

9. 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

10. Who should be Mobilized? • Support Groups • CBOs • Networks • Local Admin • MPs • Civic Leaders • NGOs (For/Not For Profit) • Businesses • Religious Orgs • Council of Elders

11. Expanding Community Based Service Delivery The Possibilities…

12. Why Community Led/Based Services • Key Unique Contribution Communities 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

13. How to Expand Community Based Services • 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

14. Community Actors Health Actors develop & manage Outputs that lead to (Community) Systems Health outcomes Other outcomes Resulting in: that they use to deliver which in turn contribute to Activities/services for communities Impacts on health Figure 2: Community action and results for health Source: GFATM CSS Framework 2010

16. 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, 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 *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

17. Individual/Family Centered • Voluntary • Community led Educate Refer Comprehensive Prevention Package PPTCT • Optimal Treatment • Easy to use • Affordable • Uninterrupted • Initiation • POC Monitoring • Support System(s)

18. 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

19. Individual/Family Centered • Voluntary • Community led • Leadership • Stewardship • Supportive Policy & Operational Plans • Resources • Man • Money • Moment Educate Refer Comprehensive Prevention Package PTCT/PMTCT • Optimal Treatment • Easy to use • Affordable • Uninterrupted • Initiation • POC Monitoring • Support System(s)

20. Ahsante Sana