Transcript Access to care and treatment for PLWHA RC/RC service

Access to care and treatment for
PLWHA
RC/RC service delivery model
International Federation of Red Cross and
Red Crescent Societies
Objectives of the mission
The objectives are to :
 assess capacity, major gaps and
opportunities
 get insight on the political commitment and
level of preparation
 develop Federation service delivery model
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Countries visited
TUNISIA
MOROCCO
ALGERIA
LIBYA
EGYPT
WESTERN
SAHARA
MAURITANIA
MALI
Criteria for selection of countries:
NIGER
ERITREA
CHAD
SUDAN
SENEGAL
THE GAMBIA
GUINEA-BISSAU
DJIBOUTI
BURKINA
TOGO
NIGERIA
GUINEA
SIERRA-LEONE
LIBERIA
COTE
D'IVOIRE
ETHIOPIA
CENTRAL
AFRICAN REPUBLIC
BENIN
GHANA
CAMEROON
UGANDA
EQUATORIAL
GUINEA
GABON
SOMALIA
KENYA
RWANDA
CONGO
BURUNDI
ZAIRE
ANGOLA
TANZANIA
 NS experience in HIV/AIDS related
programmes particularly HBC
 Burden of HIV/AIDS
 Ongoing ART initiatives by government
or other organizations
 Demonstrated government commitment
 Ongoing ART programmes by RC (Congo)
ANGOLA
ZAMBIA
MALAWI
MOZAMBIQUE
ZIMBABWE
MADAGASCAR
BOTSWANA
NAMIBIA
SWAZILAND
SOUTH
AFRICA
LESOTHO
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Method used in the study
Combination of empirical (observational)
and examination of documents conducted through :
 Organizing visits to selected organizations and
dialogue with key informants (>100)
 Collection of pertinent information from
organizations using pre-designed format
 Site visits to ART pilot areas
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Conclusion
 Governments are strongly on the move for
provision of ARVs
 ART implementation in resource-limited countries
is feasible
 RC/RC NSs are well placed to collaborate in ART
provision
 The biggest constraint is funding at community
level
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Framework of service delivery model
Core elements shaping the model/approach include:
a) Holistic approach
 Multiple intervention vital for
successful ART
 Nutritional support vital
 Community preparedness and
treatment literacy
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Framework of service delivery modelcontinue
b) Continuum of care:
 Systematic linkage of services from
hospitals to home and vice versa
 ART must be integral part of continuum of
care, treatment and prevention
c) Phased approach:
 Gradual expansion
 VCT – PMTCT/ART
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Framework of service delivery model continue
d) Use of existing structure –government/ private:
 Base on existing technical competence
 Consider long term management
e) Partnership:
 Need of multisectoral approach (food, IEC, counselling
etc.)
 Magnitude of the problem
 Concerted effort
f) NS niche:
 Define entry point based on competence and
experience
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Framework of service delivery modelcontinue
g) Focus on vulnerable groups:
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Target the marginalized ones / poor
Include RC/RC NS operation site
h) Advocacy:
 Universal access
 Urgency, replacement feeding, PMTCT- plus etc.
 Sustainable funding, price reduction
i) Resource mobilization:
 Federation Secretariat & NSs need to exert maximum effort
 Need for designing innovative approach
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Framework of service delivery modelcontinue
j) Capacity building:
 Effective intervention and expansion requires capacity
 It is an ongoing process focusing at all levels
k) Sustainability:
 Implies continuous resource mobilization
 Managerial efficiency- drug distribution
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Critical components of effective ART intervention
a) Foundation:
 Community preparation & treatment literacy
 VCT – Increased sites and accessible
 Affordability – proximity, minimize financial barrier
b) Psychological support:
 Increased number of counsellors needed
 Use professional counsellors and trained volunteers – lay
counsellors
c) Prevention (IEC, protective means):
 PLWHA and all community members need IEC
 Apply peer education, information campaign, mass media,
formal education
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Critical components of effective ART intervention continue
d) Food security and nutrition:
 Short term–food parcel for PLWA & family members
 Education on proper diet
 Medium term – Agricultural inputs for rural and semi-urban .
Mobilize community support
e) Other support:
 Provision of potable water-helps replacement feeding too
 Environmental sanitation
 Support to OVC (schooling, nutrition, legal support)
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Critical components of effective ART intervention
- continue
f) PMTCT and PMTCT-plus:
 Education and sensitization
 Counselling
 ART – preventive and HAART
 Monitor adherence
g) Clinical management - ART and OIs:
 DX and clinical management as per protocol (country /WHO)
 Patient selection - clinical and social criteria, committee
 Simplification of ART regimen – standardization, fixed
combination, involve mid level HCWs
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Critical components of effective ART intervention continue
h) Promotion of adherence to ART:
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Minimize pill count – triple combination
Family support
DOTS approach
Nutritional support
Community support- destigmatization, peer support
Patient education
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Critical components of effective ART intervention continue
j) Drug procurement and distribution
 Drug selection
 Suppliers selection
 Quality control
 Distribution and rational use of drugs
N/B The procurement of drugs will be done using the already
Existing government approved system.
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Federation care and treatment service delivery model
HBC, Peer education & wat/ san
RC provides
ARVs & OI drugs
& infrastructure
upgrading
Support to
MOH
CLINICAL
MANAGEMENT
• Laboratory service
• Diagnosis, care and
treatment
• Patient follow up
• Counselling
• Community education- treatment literacy
• Anti stigma campaign & preventive measures
• Mobilize community support for PLWHA
• Support adherence to ART
• Food support to PLWHA & family members
• Provision of other support: water, OVC etc.
• ART
RC supports
VCT & PMTCT
in testing & counselling
by collaborating with
NGO running testing
services
VCT
PMTCT
Adherence
Monitoring
• Patient
referral
• PMTCT
plus
PLWHA
Family
members
VCT
PMTCT
Testing
Counselling
Services
NSs involvement in comprehensive ART intervention
Role of agencies in holistic ART interventions
COMMUNITY
MOBILIZATION
CLINICAL CARE
FOLLOW-UP AND SUPPORT
Adherence
Monitoring
IEC
Community
treatment
literacy
VCT
PMTCT
Advocacy
RC/NSs
CBOs
NGOs
PLWHA
Patient
selection
Lab. Test
VCT
MOH
NGO-medical
RC/NSs
M
O
COMMITTEE:
H
-MOH
-- PLWHA
-- Community
representative
Diagnosis
and
Home based care
Drug
Supply
Treatment
ART &OIs
M.O.H.
ChurchWHO/CDC
Medical NGO
RC/NS running
Medical centres
Nutritional supporl
Support to OVC
Education families
+ patients
MOH
NGO-medical
RC/NSs
RC/NSs
CBOs
CHURCH
PLWHA organizations
Govn./ authorities
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Elements to be considered in programme management
Put in place sound management structure that expedites efficiency.
Some aspects to consider include:
a)
Coordination :
 Involve stakeholders from planning to implementation
 Establish smooth information exchange mechanism
 Establish small coordination committee
b)
Financial administration:
 Put in place a system that promote transparency and
accountability
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Elements to be considered in programme management
continue
c)
Reporting:
 User friendly format that captures relevant information
 Regularity in reporting based on agreed frequency
d)
Monitoring and evaluation:
 Define process, output and impact indicators
 Strong monitoring mechanism needs to be in place
 Mid term evaluation after 2 years and final end 5years
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Elements to be considered in programme management
continue
e) Institutional arrangement
Well defined collaborative arrangement is vital; thus the need for
MOU which captures:
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Areas of responsibility
Division of task- areas of implementation
Information exchange mechanism
Target population
Mechanism for expediting collaborative efforts i.e.
committee, etc.
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