14th August, 2008
AMREF has called on governments, NGOs and other players in the health sector to ensure that communities are integrated in health systems planning and development to effectively meet the health needs of those communities.
Speaking at a satellite session on ‘Engaging Communities Living with HIV in Service Delivery’ at the ongoing International AIDS Conference, AMREF’s Director for Community Partnering Dr Daraus Bukenya said that health systems could gain tremendously by effectively involving People Living with HIV (PLHIV) in treatment and care.
“By not involving PLHIV in development of policy and practice regarding treatment and care, opportunities are missed for strengthening health systems, for harnessing human resources and for closing gaps in the system that prevent people from receiving quality health care,” Dr Bukenya said. “AMREF’s strategy is to engage communities as partners in health service delivery so that they are part and parcel of the health systems. The capacity of communities must be built to enable them to be an effective part of the system and they must be assisted to develop partnerships and networks so that their voice is heard.”
With the health system supporting the community efforts, he said, there would not only be an increase in the use of health services and improvement in the quality of care, but also a general improvement in the health status of the communities.
Dr Elizabeth Wambua, who manages AMREF’s Zingatia Maisha Project in Kenya, presented a case study to illustrate the effectiveness of engaging people living with HIV (PLHIV) in service delivery. The project seeks to strengthen the capacity of government health facilities to treat and care for PLHIV, to strengthen community support groups, and to establish and institutionalise linkages between the two.
Funded by GlaxoSmithKline’s Positive Action programme, Zingatia Maisha (Carefully consider life) was started in 2006 to promote adherence following the rapid scale-up of antiretroviral treatment (ART). UNAIDS reports that in only six years, the number of people receiving ART in low- and middle-income countries has increased ten-fold, reaching almost 3 million people by the end of 27, and in the process saving lives, improving quality of life and contributing to the rejuvenation of households, communities and entire societies. In Kenya, however, where there are 164,000 people currently on treatment, cases of default are high.
“Some of the factors that affect adherence include stigma, lack of awareness of the dangers of defaulting, lack of effective referral systems, and lack of effective continuing support for those on treatment. Toxicity and the side-effects of the drugs also discourage some people from taking their treatment,” Dr Wambua explained.
The project, which was pioneered in Eastern, Western and Nairobi Provinces, has been highly successful, helping to trace 98 per cent of defaulters. By establishing and strengthening PLHIV support groups, the project ensures that those on treatment have people they can identify with and share experiences with. Each member has a `treatment buddy` who checks up on them and encourages them to take treatment correctly. Health care workers in 38 Comprehensive Care Centres (CCCs) have been trained and equipped to provide quality treatment and care to the PLHIV, and they regularly meet with leaders of the support groups to discuss how best to improve services. Members of the support groups are often called upon to escort new clients to the CCCs, which has greatly helped to encourage that those who have been referred for treatment start and adhere to the treatment.
So successful has the project been in encouraging PLHIV to start and adhere to treatment that hospitals in areas where AMREF is not working have began to adopt the model, not just for HIV treatment, but for TB as well, said Dr Wambua.
“Moreover,” added Dr Bukenya, “there have been major transformations in the health system itself because with PLHIV involved in their own treatment and care, health workers now have more time to care for other patients. This project is a learning model and we are now collecting data and evidence so that we can advocate to the government and other partners for its scale-up and replication.”