Human Rights: Displacement and Global Health: Julia Robinson

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Untangling HIV Services after a Civil War: The case of Bouake, Cote d’lvoire

Julia Robinson, Health Alliance International

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  • Human Rights: Displacement and Global Health: Julia Robinson

    1. 1. Implementing pMTCT programs in a post-conflict context: The case of Bouak é , C ô te d’Ivoire Julia Robinson, MSW MPH April 5, 2009
    2. 2. Bouak é , C ô te d’Ivoire
    3. 3. (very!) Brief history of the conflict <ul><li>Period of colonization by the French until 1960s </li></ul><ul><li>1970s-80s: “Paris of West Africa” </li></ul><ul><li>1999: Failed military coup </li></ul><ul><li>2000: Contested election </li></ul><ul><li>2002-??: Civil War </li></ul><ul><ul><li>Bouaké was the rebel stronghold </li></ul></ul>
    4. 4. Effects of the conflict <ul><li>Destruction of health care sites </li></ul><ul><li>Health care workers fled the region </li></ul><ul><li>Fragmentation of services </li></ul><ul><li>HIV care decentralized to NGO delivery </li></ul>
    5. 5. NGOs in Bouake, Cote d’Ivoire (2007)
    6. 6. Health care workers fled the region
    7. 7. Goals/objectives of study (1) <ul><li>Goals: </li></ul><ul><ul><li>provide baseline information for program development and, </li></ul></ul><ul><ul><li>given a limited capacity to deliver care, suggest strategies to implement integrated pMTCT services in the public health sector </li></ul></ul>
    8. 8. Goals/objectives of study (2) <ul><li>Objectives: </li></ul><ul><ul><li>describe existing ANC and HIV services available to pregnant women in Bouaké, both in the public and private sector service delivery arenas; </li></ul></ul><ul><ul><li>describe the referral and follow up systems currently operating in the project area and the barriers that may prevent pregnant women to access HIV care; and </li></ul></ul><ul><ul><li>describe patient flow through the health system from the perspective of a pregnant woman accessing ANC and HIV services. </li></ul></ul>
    9. 9. Methodology <ul><li>Nov-Dec 2007 </li></ul><ul><li>Informant interviews </li></ul><ul><li>Records reviews </li></ul><ul><ul><li>Registers, MOH data, UNICEF data </li></ul></ul><ul><li>Patient flow map </li></ul>
    10. 10. Patient flow analyses <ul><li>3 scenarios </li></ul><ul><ul><li>HIV negative seeking ANC </li></ul></ul><ul><ul><li>HIV positive not eligible for treatment </li></ul></ul><ul><ul><li>HIV positive eligible for treatment and seeking follow up services </li></ul></ul><ul><li>Cost, loss to follow up noted </li></ul>
    11. 11. Patient flow analyses <ul><li>3 scenarios </li></ul><ul><ul><li>HIV negative seeking ANC </li></ul></ul><ul><ul><li>HIV positive not eligible for treatment </li></ul></ul><ul><ul><li>HIV positive eligible for treatment and seeking follow up services </li></ul></ul><ul><li>Cost, loss to follow up noted </li></ul>
    12. 12. The grand prize! <ul><li>8 visits, 5 sites </li></ul><ul><li>1 week – 1 month (or more??) </li></ul><ul><li>A total nightmare! </li></ul>
    13. 13. Discussion <ul><li>Fragmentation of care </li></ul><ul><ul><li>Public system provides ANC, NGOs provide HIV care </li></ul></ul><ul><ul><li>Causes: post war, NGO proliferation and competition, inadequate HR in public sites </li></ul></ul><ul><li>Loss to follow up – unknown? </li></ul><ul><ul><li>HCW report only 20% of women return for results </li></ul></ul><ul><ul><li>Causes: referrals, stigma, costs </li></ul></ul>
    14. 14. Recommendations <ul><li>Integrated scale up of pMTCT in ANC </li></ul><ul><ul><li>Onsite testing using rapid tests to cut out loss to follow up </li></ul></ul><ul><li>Better collaboration between MOH and NGOs </li></ul><ul><li>HIV care integrated into general care at public health sites </li></ul>
    15. 15. 15 months later… <ul><li>Integrated pMTCT in 18 Bouake health facilities </li></ul><ul><li>More than 12,000 women tested for HIV, sero-prevalence rate of 5.7% </li></ul><ul><li>CD4 sample transportation system set up at all sites </li></ul><ul><li>PLWHA support groups at health facility sites </li></ul>
    16. 16. Progression and possibility <ul><li>Expansion to other districts </li></ul><ul><li>Expansion of activities within VB </li></ul><ul><li>Greater integration with TB programs, inpatient wards, malnutrition units… </li></ul>
    17. 17. Thank you! <ul><li>Acknowledgments </li></ul><ul><ul><li>MOH Vall é e du Bandama </li></ul></ul><ul><ul><li>HAI-Seattle </li></ul></ul><ul><ul><li>HAI-CI </li></ul></ul><ul><ul><li>UNICEF-CI </li></ul></ul><ul><ul><li>The Kon é family </li></ul></ul>
    18. 18. Questions?

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