Regional Workshop for Costing eMTCT National Strategies: Understanding Community Engagement in eMTCT Community Engagement Working Group Lucy Ghati, NEPHAK/GSG.

Regional Workshop for Costing eMTCT Regional Workshop for Costing eMTCT National Strategies: National Strategies:

Understanding Community Engagement in Understanding Community Engagement in eMTCTeMTCT

Community Engagement Working GroupLucy Ghati, NEPHAK/GSG Representative

3 September 2012

OverviewOverview

I. Who We AreII. Who is the “Community”?III. What is Community EngagementIV. Why is Community Engagement ImportantV. How to Engage CommunitiesVI. How to Include Community Engagement in

National eMTCT PlansVII.Who Can Provide Technical Support?VIII.Questions

Who We Are: Community Who We Are: Community Engagement Working Group (CEWG)Engagement Working Group (CEWG)

• Recently formed IATT Working Group• Co-Chaired by GNP+ and CDC

To provide Global Plan countries with (1) practical tools and (2) technical assistance for developing, implementing, managing, and monitoring community engagement programs addressing the Global Plan goals and objectives.

1

Workgroup ObjectiveWorkgroup Objective

Who is the Who is the “Community”?“Community”?

Communities are groups of people linked by common ties.

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

2

What is “Community Engagement”?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.

3

Why is Community Why is Community Engagement Engagement IMPORTANT?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 eMTCT care and ensures that they also get the services they need, Improves equitable outcomes and reaches underserved

populations.

4

How Can our Communities Engage in How Can our Communities Engage in this Work to Achieve Rapid Scale-up?this Work to Achieve Rapid Scale-up?5

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

Improve supply & quality of Improve supply & quality of

servicesservices

Communities can improve the supply and quality of services by:

Supporting front-line health care workers e.g. community based distribution of family planningServing as extension workers 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)

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

Community workers reach into communities to link individuals into services and trace those lost to follow-up

Monitoring governments and health facilities to hold them accountable for providing services that suit the needs of women, men and children

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 and resources Creating demand through treatment literacy and

awareness of availability of services Supporting community led health promotion campaigns

to create demand and increase uptake

IncreaseIncrease uptake of uptake of

servicesservices

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 Reducing stigma and discrimination

Create an Enabling Create an Enabling

EnvironmentEnvironment

How To Include Community How To Include Community Engagement in National eMTCT Plans?Engagement in National eMTCT Plans?

Include & budget for the following:

1. Establish and strengthen community-based support services (including FBOs and PLHIV )

2. Train community workers (e.g. people living with HIV, mentor mothers, community health workers, peer educators, etc.) to deliver comprehensive prevention of vertical transmission services

3. Community-based support for linkages to and retention in facility-based services

4. Support and provide community education and awareness 5. Strengthen and encourage community-led program

accountability

6

Positive aspects of Community Positive aspects of Community Engagement in PlansEngagement in Plans

Gender-sensitive approaches for engaging both men and women e.g. health development army and women’s coalitions in Ethiopia

Strategies for reaching underserved populations e.g. Ghana and Zambia financial reimbursements for poor women accessing PMTCT services

Peer support groups e.g. Kenya and Mozambique Community distributors of family planning services e.g.

Malawi and Mozambique Health management committees with community

participation e.g. Kenya Building capacity of community support groups including

PLHIV to support treatment adherence including through home based care e.g. Nigeria

Budgets for CE do not reflect narrative e.g. lack of budget for capacity building of CBOs to provide outreach to households affected by HIV

Limited focus on local accountability mechanisms to support planning, implementation and monitoring of EMTCT response

Limited consideration of community based structures outside of the health sector (faith based organisations, social welfare structures etc)

Lack of clarity on role of PLHIV in planning and monitoring responses

Limited focus on activities to reduce HIV related stigma and discrimination

Areas for strengthening Areas for strengthening community engagementcommunity engagement

IATT Community Engagement Work Group Brochures

“Supporting and Strengthening community engagement towards achieving zero new HIV infections among children and keeping their mothers alive” – Introduction to Community Engagement

“Communities taking action for women, mothers and children” – Suggestion of Promising Practices

Checklist of Minimum Community Engagement Activities

GSG Civil Society Representatives UNAIDS Community Mobilization Team Community groups working locally, in particular

networks of women living with HIV and service providers working directly with mothers living with HIV

7Who can provide Technical Who can provide Technical Support? Support?

We need to allocate a budget that will meet the full costs of community engagement.

NACC/NACA should work with development partners to roll out a national plan that will implement revised WHO guidelines and reduce stigma in health care facilities

NACC/NACA, in collaboration with community groups, should develop strategies to keep women engaged in follow-up treatment and care services

We need to wholeheartedly involve women groups in mother and child health care

Women’s groups must be represented in the national eMTCT platforms and relevant advocacy discussions

Most Most Importantly…Importantly…

We are ready and able to help.

Email: Georgina Caswell [email protected] Medley [email protected]

(Co-chairs of CEWG)

Questions?Questions?