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02 Sahara Presentation Ogunyemi Foluke Adetola


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02 Sahara Presentation Ogunyemi Foluke Adetola

  1. 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 1
  2. 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. 2
  3. 3. Community dialogue session to kick start MHCT 3
  4. 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. 4
  5. 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. 5
  6. 6. Methodology: A ten-point intervention strategy was used during the LMS-ACT project (project duration: nine months) Management Sciences for Health (MSH) 6
  8. 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 8
  9. 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 9
  10. 10. Methodology •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 Management Sciences for Health (MSH) 10
  11. 11. Methodology continued •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. Management Sciences for Health (MSH) 11
  12. 12. Results •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. Management Sciences for Health (MSH) 12
  13. 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.” 13
  14. 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”. 14
  15. 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”. 15
  16. 16. Management Sciences for Health Facility Summary November 2008 – July 2009 Data is cumulative from each facility inception till July 2009 16
  17. 17. Management Sciences for Health Facility Summary November 2008 – July 2009 Data is cumulative for each facility from their respective inceptions till July 2009 17
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  20. 20. Conclusion 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) 20
  21. 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 21
  22. 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) 22
  23. 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. 23
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