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Mobilizing community groups to access comprehensive care ser

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Mobilizing community groups to access comprehensive care ser

  1. 1. Mobilizing Community Groups to Access Comprehensive care; The Coast Province Example
  2. 2. RATIONALE A WAY OF PROMOTING THE USE OF ART  The community is your most important stakeholder  It has the power to kill any of your initiatives  The community has a very great interest in it‟s own health and well-being
  3. 3. Involving the community in matters related to HIV makes people feel responsible for the outcome of HIV related issues Therefore the community becomes your key ally and partners in the management of HIV.
  4. 4. COMMUNITY INVOLVEMENT IN ART  „Your health is your responsibility‟  Therefore a community‟s health is it‟s responsibility Therefore it is through the community that you are best placed to;  Advocate for prevention of new infections.  Advocate for a health seeking behavior amongst individuals of that community and the community as a whole (public health)
  5. 5. “A communities health is it‟s responsibility”  If you involve the community in all phases of ART/Tb treatment provision you empower them and the benefits are …..and because they are in control of the situation…
  6. 6.  Stigma reduces .Fear and hopelessness is replaced by positive community activity  Promotion of adherence to medication because there is motivation through community approval ,support and encouragement.
  7. 7. PROCESS  Identify a community group already involved in care e.g.  Community Health group  Home based care  Welfare (funeral) group  People at high risk CSW, Widows  PLWA  Unions and other collective agreement groups
  8. 8.  Mobilisation process- making yourself known who are you? What do you want?
  9. 9.  An entry point takes into consideration the community priorities-IGA
  10. 10. PROCESS  Tell them what the problem is exactly  Tell them what needs to be done to solve it  Define the community role after the necessary negotiations  Define your role  Define how your role links with their role  Capacity build them in areas they are deemed deficient
  11. 11. ROLE OF THE HEALTH PROVIDER  Create awareness of the availability of the service  Show them how to access it  Teach the group about the benefits they will derive from it  Encourage them to use it make it accessible  Negotiate with them on compliance issues  Ask them to spread the word to others
  12. 12.  Organizing the interaction- the power of the uniform
  13. 13. ROLE OF THE COMMUNITY GROUPS  To identify the sick and the appreciate extent of the problem  To encourage their own to seek to know if they are also infected and if they need to seek treatment (VCT,PMCTC)  To empathize with those that are sick and affected.  To support the patients physically and emotionally during diagnosis and treatment  Then help them back into mainstream society
  14. 14. EXAMPLES  Bangladesh ,Likoni, Kisauni,Bamako  Kenya Red-cross community volunteer groups Majengo  Kenya Street traders  Commercial Sex workers  MAWEO  COPE  St Josephs Shelter
  15. 15. BANGLADESH- A slum community  Located in Changamwe , Bangladesh is a typical urban slum settlement with a  Community health centre Bamako that takes care of:  Malaria, immunisations ,family planning etc  Home based care, orphans  Community T.B. DOTS  Feeding program
  16. 16.  Bangladesh Bamako- Community health centre. Using existing systems to add value
  17. 17. Bangladesh Bamako  The Bamako was initially only a community Health Initiative that; 1.Took on the role of HBC 2.Then we introduced T.B. community DOTS 3. Now HBC is being replaced by ART and community ART
  18. 18.  Advantages  Social cohesion makes follow up and adherence issues easy  In an informal settlement people are easily lost to follow up
  19. 19. COMMERCIAL SEX WORKERS Community group at high risk Kisauni CSW group Rationale: CSW have the potential to act as a reservoir and a vector at the same time.  Peer education, group support and influencing amongst the CWS affords an opportunity  PROCESS-  Group support -VCT-From VCT to ART  Benefits include curbing further spread through their line of work  They are able to do something about their occupational hazard
  20. 20. Coast People living with HIV COPE a community group  They have been very instrumental in lobbying for development of ART services  They highlight deficiencies in our program  Act as a checks and balances-
  21. 21. Kenya Street traders - the informal sector  RATIONALE This is a difficult to reach group and can easily fall through the gaps. They are also a very powerful group.  Kongowea Market  Encourage each other to go for VCT, capacity build themselves now looking forward to working with NHIF  Reduction in funerals already noted due to their actions.
  22. 22. Community programs by large estates  Rea Vipingo – an NGO-GOK-Private sector partnership  Community outreach program doing VCT and referring patients for treatment  Management support the process
  23. 23. ST.JOSEPHS SHELTER OF HOPE- community support by an FBO  St. Josephs Shelter of Hope  Started as a health clinic with an orphan support program  Went on to treat residents from the area with T.B. and opportunistic infections.  Coordinates with Voi District hospital which provides a clinical officer and drugs  Ready for ART  Social /FBO/Government partnership
  24. 24. MAWEO Women‟s group Kwale District  Educated (read empowered) community women group  Difficult District with bad stigma issues  Lobbying the community to accept HIV and go for VCT and treatment  Latest figures >80% acceptance of PMCT by women visiting ante-natal clinic  Those positive will enroll for PMCTC+
  25. 25. KENYA REDCROSS MOMBASA HOMEBASED CARE PROGRAM organized volunteer community groups  YOUTH  Majengo slum  Linkages are well developed between the community volunteers, CHW, and local health institutions  Clear example of how to move from Volunteerism- HBC-ARV with the desired linkages.  Adherence issues are simplified.
  26. 26.  Our concern- How are communities coping on their beach plot
  27. 27.  They are helping themselves on their own…but how ?
  28. 28.  Tell them the problem –show them a solution give them control
  29. 29.  If the neighbours are willing….
  30. 30. Show them how -Kenya Red cross/neighbour
  31. 31. Community interaction-training
  32. 32. CWS can take care of themselves
  33. 33. LINKAGES  Do not try to do everything yourself you are not taking over the community responsibility  NGO/CBO with community HBC  Community HBC with Community Health worker  Community health worker with Government/other clinic  Clinic Links with and is answerable to DMOH