The Importance of Community Engagement in the Global Plan Towards the Elimination

of New Infections and Keeping their Mothers Alive

Community Engagement Working GroupAngelina Namiba, Positively UK

31 October 2012

OverviewI. Who is the “Community”?II. What is Community Engagement?III. Why is Community Engagement

Important?I. Examples of Successful Community Engagement

Initiatives around Prevention of Vertical Transmission

IV. How can communities be supported?V. Questions

Who is the “Community”?

Communities are groups of people linked by common ties (e.g. cultural identity, geographic place).

Within the HIV response these communities include:

networks of people living with HIV, community leaders, service users, faith-based organizations, advocacy groups men, women, boys and girls actual communities – towns, villages, groups of people

living together

1

What is “Community Engagement”?

Community engagement is a process by which the community is engaged to:

work collaboratively with national and local health authorities, facility and community based medical service providers, legislators, advocacy groups, donors and others engaged in efforts to develop, implement and evaluate Global Plan related care;

empower women and their communities to access health care and hold those who provide it accountable.

2

Why is Community Engagement IMPORTANT?

Community Engagement is important because it:

Increases demand for services Improves client retention Improves uptake of and adherence to interventions that

will achieve Global Plan goals and objectives. Addresses HRH/HSS issues by engaging a massive potential

workforce by enlisting communities in the provision of care; Builds strong linkages between health facilities and

communities Brings men and families into comprehensive PVT care and

ensure that they also get the services they need.

3

How Can our Communities Engage in this Work to Achieve Rapid Scale-up?

Communities can:

Improve the supply and quality of services Increase the uptake of services, including ARV

adherence and facility delivery and follow-up Create an enabling environment

4

Improve supply & quality of services

Communities can improve the supply and quality of services by:

Serving as extension workers and expanding and supporting front-line health care workers e.g. community based distribution of family planning,

Creating links between community- and faith-based organizations and facility-based services,

Monitoring and holding governments accountable to provide services that suit the needs of women, men and children.

Having peer educators and mentor mothers in health facilities provide education and support where there are too few doctors and nurses (HSS/HRH/Task shifting and sharing)

Having community workers reach into communities Holding health facilities as well as governments accountable.

Engaging women living with HIV as mentor mothers

714 sites in nine countries Mothers living with HIV are recruited, salaried, trained, supervised,

and engage in career development From Pregnancy to Baby and Beyond Project , London Results:

Increased ARV uptake: In Kenya, rates of ARV uptake among women who interacted with mentor mothers at least 4 times was 97% compared with 62% among women with no interaction

Increased postpartum CD4 testing Increased treatment initiation Increased HIV disclosure Increased infant testing

From Pregnancy to Baby and Beyond Project , London

Mothers2Mothers

In Uganda, 50 communities were informed of their rights and issued with “report cards” Communities encouraged to identify solutions, develop

remedial action plans, and implement and monitor them Meetings were held with community members and health

facility staff to create a jointly-owned action plan Approximately 55,000 households were reached Results (in 1 year):

Increase in antenatal visits, facility deliveries and family planning visits Increase in infant weight for age 33% reduction in deaths among children under 5

Community Engagement in Monitoring

Services

Communities can increase the uptake of services (including ARV adherence and facility delivery and follow-up) by: Participating in campaigns for behavior change and

reduction of discrimination, Providing peer support, Maximizing the use of community assets, resources, and Creating demand through treatment literacy and

awareness of availability of services Supporting community led health promotion campaigns

to create demand and increase uptake

Increase uptake of

services

The Catholic Medical Mission Board developed a communication strategy to promote male involvement in reducing pediatric HIV Engaged traditional leaders as allies and champions of

prevention of vertical transmission (PVT) Identified male attitudes/practices that negatively impact

women’s access to services and developed a community education strategy

Results Within 5 months, 65% of 2,261 men in the program tested for HIV (11%

baseline) 4x increase in same day counseling and testing of pregnant couples Antenatal clinic clients’ acceptance of HIV counseling and testing rose of

95% (60% baseline) Acceptance rates for ARV prophylaxis or treatment among women who

tested positive rose to 70% (40% baseline)

Involving Men in Zambia

In the Nyimbwa Multipurpose Self-Help Group, people living with HIV are selected as Network Support Agents (NSA) Trained in ARV adherence, nutrition, pregnancy and HIV,

disclosure, and counseling Spend 2 days/week in a health clinic and 3 days in the

community to mobilize people to use clinic-based services and support services

Results Decreasing stigma and discrimination in the community and in

hospitals In one of the 40 districts where NSA operated, the number of people

accessing PVT services increased from 1,294 to 15,892

Peer Extension Workers in

Uganda

Communities can create an enabling environment by:

Advocating for scale-up and the right to sexual and reproductive health,

Promoting community engagement in policies and strategies.

Addressing HIV related stigma and discrimination and gender inequalities

Participating in technical working groups

Create an Enabling

Environment

Treatment Action Campaign (TAC) pressured the Government to roll out ARVs for PVT Advocacy included human rights education,

treatment literacy, public demonstrations and litigation

In-service trainings of health clinic staff and clients

Trace contracts and measure adherence Media and door-to-door campaigns

Community Mobilization in South

Africa

How can communities be supported?

A sustained process that enables community members to participate in program design, implementation and monitoring

This in turn requires:

Financial and technical support and investment to build skills and to coordinate and implement programs

Meaningful involvement of networks of people living with HIV, the people who are most committed to having healthy, HIV-free babies

Training and on-going supervision

We are ready and able to help.

Email: Georgina Caswell (gcaswell@gnpplus.net)Amy Medley (igm8@cdc.gov)

Questions?