Mobilizing Community Mobilizing Community Groups to Access Groups to Access

Comprehensive care;Comprehensive care;

The Coast Province ExampleThe Coast Province Example

RATIONALERATIONALE

A WAY OF PROMOTING THE USE A WAY OF PROMOTING THE USE OF ARTOF ART

The community is your most important The community is your most important stakeholderstakeholder

It has the It has the powerpower to kill any of your initiatives to kill any of your initiatives

The community has The community has a very great interesta very great interest in in it’s own health and well-beingit’s own health and well-being

Involving the community in matters Involving the community in matters related to HIV related to HIV makes people feel makes people feel responsibleresponsible for the outcome of HIV for the outcome of HIV related issuesrelated issues

Therefore the community becomes your Therefore the community becomes your key ally and partners in the key ally and partners in the management of HIV. management of HIV.

COMMUNITY INVOLVEMENT IN COMMUNITY INVOLVEMENT IN ARTART

‘‘Your health is your responsibility’Your health is your responsibility’Therefore a community’s health is it’s Therefore a community’s health is it’s

responsibilityresponsibilityTherefore it is through the community that Therefore it is through the community that

you are best placed to;you are best placed to;Advocate for prevention of new infections.Advocate for prevention of new infections.Advocate for a health seeking behavior Advocate for a health seeking behavior

amongst individuals of that community amongst individuals of that community and the community as a whole (public and the community as a whole (public health)health)

““A communities health is it’s A communities health is it’s responsibility”responsibility”

If you involve the community in all If you involve the community in all phases of ART/Tb treatment phases of ART/Tb treatment provision you empower them and the provision you empower them and the benefits arebenefits are

……....and because they are in control of the and because they are in control of the situationsituation……

Stigma reduces .Fear and hopelessness Stigma reduces .Fear and hopelessness is replaced by positive community is replaced by positive community activityactivity

Promotion of adherence to medication Promotion of adherence to medication because there is motivation through because there is motivation through community approval ,support and community approval ,support and encouragement.encouragement.

PROCESSPROCESS

Identify a community group already Identify a community group already involved in care e.g.involved in care e.g.Community Health groupCommunity Health groupHome based careHome based careWelfare (funeral) groupWelfare (funeral) groupPeople at high risk CSW, WidowsPeople at high risk CSW, WidowsPLWAPLWAUnions and other collective agreement Unions and other collective agreement

groupsgroups

Mobilisation process- making yourself known who are you? What Mobilisation process- making yourself known who are you? What do you want?do you want?

An entry point takes into consideration the community priorities-An entry point takes into consideration the community priorities-IGAIGA

PROCESSPROCESS

Tell them what the problem is Tell them what the problem is exactlyexactly

Tell them what needs to be done to Tell them what needs to be done to solve itsolve it

Define the community role after the Define the community role after the necessary negotiations necessary negotiations

Define your roleDefine your role Define how your role links with their roleDefine how your role links with their role Capacity build them in areas they are Capacity build them in areas they are

deemed deficientdeemed deficient

ROLE OF THE HEALTH PROVIDER ROLE OF THE HEALTH PROVIDER

Create awareness of the availability Create awareness of the availability of the service of the service

Show them how to access itShow them how to access it Teach the group about the benefits they Teach the group about the benefits they

will derive from itwill derive from it Encourage them to use it make it Encourage them to use it make it

accessibleaccessible Negotiate with them on compliance issuesNegotiate with them on compliance issues Ask them to spread the word to othersAsk them to spread the word to others

Organizing the interaction- the power of the Organizing the interaction- the power of the uniformuniform

ROLE OF THE COMMUNITY ROLE OF THE COMMUNITY GROUPSGROUPS

To identify the sick and the appreciate extent To identify the sick and the appreciate extent of the problemof the problem

To encourage their own to seek to know if To encourage their own to seek to know if they are also infected and if they need to they are also infected and if they need to seek treatment (seek treatment (VCT,PMCTC)VCT,PMCTC)

To empathize with those that are sick and To empathize with those that are sick and affected. affected.

To support the patients physically and To support the patients physically and emotionally during diagnosis and treatment emotionally during diagnosis and treatment

Then help them back into mainstream societyThen help them back into mainstream society

EXAMPLESEXAMPLES

Bangladesh ,Likoni, Kisauni,BamakoBangladesh ,Likoni, Kisauni,BamakoKenya Red-cross community Kenya Red-cross community

volunteer groups Majengovolunteer groups MajengoKenya Street tradersKenya Street tradersCommercial Sex workersCommercial Sex workersMAWEOMAWEOCOPECOPESt Josephs ShelterSt Josephs Shelter

BANGLADESH-BANGLADESH- A slum community A slum community

Located in Changamwe , Bangladesh is Located in Changamwe , Bangladesh is a typical urban slum settlement with aa typical urban slum settlement with a

Community health centre Bamako that Community health centre Bamako that takes care of:takes care of:

Malaria, immunisations ,family planning etcMalaria, immunisations ,family planning etc Home based care, orphansHome based care, orphans Community T.B. DOTSCommunity T.B. DOTS Feeding programFeeding program

Bangladesh Bamako- Community health centre. Bangladesh Bamako- Community health centre. Using existing systems to add valueUsing existing systems to add value

Bangladesh BamakoBangladesh Bamako

The Bamako was initially only a The Bamako was initially only a community Health Initiative that;community Health Initiative that;

1.Took on the role of HBC1.Took on the role of HBC

2.Then we introduced T.B. community 2.Then we introduced T.B. community DOTSDOTS

3. Now HBC is being replaced by ART 3. Now HBC is being replaced by ART and community ARTand community ART

AdvantagesAdvantagesSocial cohesion makes follow up and Social cohesion makes follow up and

adherence issues easyadherence issues easy

In an informal settlement people are In an informal settlement people are easily lost to follow upeasily lost to follow up

COMMERCIAL SEX WORKERSCOMMERCIAL SEX WORKERSCommunity group at high riskCommunity group at high risk

Kisauni CSW group Rationale: Kisauni CSW group Rationale: CSW have the potential to act as a reservoir CSW have the potential to act as a reservoir

and a vector at the same time.and a vector at the same time. Peer education, group support and Peer education, group support and

influencing amongst the CWS affords an influencing amongst the CWS affords an opportunityopportunity

PROCESS-PROCESS- Group support -VCT-From VCT to ARTGroup support -VCT-From VCT to ART Benefits include curbing further spread through Benefits include curbing further spread through

their line of worktheir line of work They are able to do something about their They are able to do something about their

occupational hazardoccupational hazard

Coast People living with HIVCoast People living with HIVCOPE a community groupCOPE a community group

They have been very instrumental in They have been very instrumental in lobbying for development of ART lobbying for development of ART servicesservices

They highlight deficiencies in our They highlight deficiencies in our program program Act as a checks and balances-Act as a checks and balances-

Kenya Street tradersKenya Street traders- the informal sector- the informal sector

RATIONALE This is a difficult to reach RATIONALE This is a difficult to reach group and can easily fall through the group and can easily fall through the gaps. They are also a very powerful gaps. They are also a very powerful group.group.

Kongowea MarketKongowea MarketEncourage each other to go for VCT, Encourage each other to go for VCT,

capacity build themselves now looking capacity build themselves now looking forward to working with NHIFforward to working with NHIF

Reduction in funerals already noted due to Reduction in funerals already noted due to their actions.their actions.

Community programs by large Community programs by large estatesestates

Rea Vipingo – an NGO-GOK-Private Rea Vipingo – an NGO-GOK-Private sector partnershipsector partnershipCommunity outreach program doing Community outreach program doing

VCT and referring patients for treatmentVCT and referring patients for treatmentManagement support the processManagement support the process

ST.JOSEPHS SHELTER OF HOPE- ST.JOSEPHS SHELTER OF HOPE- community support by an FBOcommunity support by an FBO

St. Josephs Shelter of HopeSt. Josephs Shelter of HopeStarted as a health clinic with an orphan Started as a health clinic with an orphan

support programsupport programWent on to treat residents from the area Went on to treat residents from the area

with T.B. and opportunistic infections.with T.B. and opportunistic infections.Coordinates with Voi District hospital Coordinates with Voi District hospital

which provides a clinical officer and drugs which provides a clinical officer and drugs Ready for ARTReady for ARTSocial /FBO/Government partnershipSocial /FBO/Government partnership

MAWEOMAWEOWomen’s group Kwale DistrictWomen’s group Kwale District

Educated (read empowered) community Educated (read empowered) community women groupwomen group

Difficult District with bad stigma issuesDifficult District with bad stigma issuesLobbying the community to accept HIV Lobbying the community to accept HIV

and go for VCT and treatmentand go for VCT and treatmentLatest figures >80% acceptance of PMCT Latest figures >80% acceptance of PMCT

by women visiting ante-natal clinicby women visiting ante-natal clinicThose positive will enroll for PMCTC+ Those positive will enroll for PMCTC+

KENYA REDCROSS KENYA REDCROSS MOMBASA HOMEBASED CARE PROGRAMMOMBASA HOMEBASED CARE PROGRAMorganized volunteer community groupsorganized volunteer community groups

YOUTHYOUTHMajengo slumMajengo slumLinkages are well developed Linkages are well developed

between the community volunteers, between the community volunteers, CHW, and local health institutionsCHW, and local health institutions

Clear example of how to move from Clear example of how to move from Volunteerism- HBC-ARV with the Volunteerism- HBC-ARV with the desired linkages.desired linkages.

Adherence issues are simplified. Adherence issues are simplified.

Our concern- How are communities coping on Our concern- How are communities coping on their beach plottheir beach plot

They are helping themselves on their own…but They are helping themselves on their own…but how ?how ?

Tell them the problem –show them a solution give them Tell them the problem –show them a solution give them controlcontrol

If the neighbours are willing….If the neighbours are willing….

Show them how -Kenya Red cross/neighbourShow them how -Kenya Red cross/neighbour

Community interaction-Community interaction-trainingtraining

CWS can take care of CWS can take care of themselvesthemselves

LINKAGESLINKAGES

Do not try to do everything yourself Do not try to do everything yourself you are not taking over the community you are not taking over the community responsibilityresponsibilityNGO/CBO NGO/CBO withwith community HBC community HBCCommunity HBC Community HBC withwith Community Health Community Health

workerworkerCommunity health worker Community health worker with with

Government/other clinicGovernment/other clinicClinic Links Clinic Links withwith and is answerable to and is answerable to

DMOHDMOH