DSD training

1. Differentiated Service Delivery
models for Kps: setting up OSS

2. Models of service provision
• Three main models of service provision for
KP members:
– Stand alone (OSS/DIC)
– Integrated
– Outreach

3. How to establish OSS
• Plan number and location of the OSS
• Select and prepare the premises
• Recruit clinic/OSS staff
• Train staff and service providers
• Form committees

4. Plan number and location
• Consultation with KP members is key
• Guided by microplanning – hotspot maps to
determine number and location of OSS
• Should be accessible to KPs – location near
where KPs are concentrated
• Need to link it to the community for services
– ORW, peer educators, peer educator ratio
(different for different KP members)

5. Selecting and preparing the premises
• Involve the KP members – participation in
painting/renovating/arranging the facility
• Have minimum standards for the premises:
– Reception/waiting bay, clinical exam
room, counselling room, lavatory
(separate for different sexes)
• Consider flow through the OSS
• Ensure as much as possible to have a safe
space within the OSS

6. Setting up cont.
• Waiting bay/reception
– Can double up for meetings eg PE
monthly meetings
– Should have basic information for clients
waiting to see counsellor or clinician eg
signs showing OSS hours, chart showing
clinic flow, patients’ rights charter, service
charter, statement on S&D, IEC material,
condoms and lubes, entertainment
center, comment/suggestion box. Sharps
container for PWID

8. Setting up cont.
• Clinic rooms
– Set up minimum standards eg running
water, waste disposal facilities, power
supply, examination couch, sterile
equipment at all times, PPE, privacy (door,
curtains – music in some cases), male and
female condoms and dildos/models for
demonstration, tables and chairs arranged
optimally, appropriate materials on the
walls, appropriate reporting tools, drug
cabinet

9. Setting up cont.
• Counselling rooms
– Desk, worktable and at least 3 chairs
– Basic HIV test kits and storage facilities eg
fridge
– Running water
– PPE
– Condoms, lubes, dildos/models for
demonstration
– Lockable filing cabinets
– Privacy – door/music

10. Setting up cont.
• Records room/data room
– Secure location – not accessed by all
– Enough lockable filing cabinets
– Computers/internet
– Tables/chairs
– Ventilation

11. Setting up cont.
• Lavatory
– Toilet
– Wash basin with running water
– Lights
– Cleaning supplies (detergent, etc)
– Towels, soap for bathing, mirror
– Toilet paper
– A locking door

15. Setting up outreach clinics
• Requirements similar to static OSS BUT have
to make due with what is available in the
field
• Must have basic minimums as well eg
privacy, waiting areas, clean water supply for
clinical areas, PPE, examination ‘couch’
where possible, adequate lights for
examination

16. Outreach
clinics cont

17. Recruiting staff
• Decide on basic minimum staffing per OSS
– Clinician, counsellor, ORW, PEs, data
officer, front office staff, clinic coordinator,
caretaker
• Decide on basic qualifications of each staff
• Create JDs, roles and responsibilities
• Decide on organizational structure
• Prioritize KP members for staffing if feasible

18. Training staff
• Ensure all staff receive training and/or
sensitization on provision of KP friendly
services (stigma, discrimination)
• Train staff based on expected duties:
– Clinicians: STIs, ART provision, HTS,
gender based violence
– Counsellors: HTS, harm reduction, sex and
sexuality

19. Training staff cont.
– ORW and PES: basic training so that they
know how to refer clients to the OSS eg
sensitization on types of services provided
at the OSS, condom and lubes
demonstration, basic knowledge of HIV
and STIs
• NB: all staff should be trained on reporting
tools needed for data collection at their
stations.

20. Form committees
• Three main types:
– KP clinic committee
– Infection prevention and control
committee
– Continous quality improvement
committee

21. Operating the OSS
• Demand creation activities
• Operating hours – standard hours usually 8-
8, consult KP if need to change
– Ideally open 7 days a week but this can be
reviewed in consultation with KP members. For
PWID, this is however necessary
– Operating hours at outreach vary depending on
findings of microplanning
• OSS flow: reception, counselling, clinic,
counselling, reception

22. Waste management
• MUST be considered from the beginning
• Appropriate waste segregation and disposal
at OSS and outreach must be in place
• Training of all clinicians and counsellors
• SOPs for handling, transport and disposal of
waste need to be created and followed
• Private waste management facilities or MOH
facilities can help with disposal of
biohazardous material

23. Other considerations
• Rules and regulations of the OSS – let the
KPs make these or have majority input
– Dispute resolution if rules broken

27. Acknowledgments