the role of community in the hiv and aids response
DESCRIPTION
OVERVIEW Where the Tide Will Turn: How is Community Level Participation Most Effective in Turning the Tide? Roxana Rogers, Director Office of HIV/AIDS, Global Health Bureau United States Agency for International Development (USAID ) Washington. - PowerPoint PPT PresentationTRANSCRIPT
OVERVIEW
Where the Tide Will Turn: How is Community Level Participation Most Effective in Turning the Tide?
Roxana Rogers, DirectorOffice of HIV/AIDS, Global Health Bureau
United States Agency for International Development (USAID) Washington
AIDS 2012 - Turning the Tide Together
The Role of Community in the HIV and AIDS Response
• The role of Community has been essential and multifaceted.
• Community-based leaders, volunteers, workers and networks contribute immensely to the response and the achievements at different stages of the epidemic.
• Over three decades, USAID has supported strategic community programs to ensure a sustained response.
Spectrum of Effective Community Interventions
• In sub-Saharan Africa the community is uniquely positioned to effectively engage in the global HIV response through a spectrum of interventions: – Creating linkages between community
and clinic– Care and support of people living with
and affected by HIV, including orphans, women and families
– Adherence support– Innovative economic strengthening
activities – Facilitating the scale-up of treatment
and prevention interventions
Evidence SummitThree evidence review teams were formed to review both peer‐reviewed and gray literature
5
• Most studies limited in scope – only 1 or 2 program factors at most and few studies used rigorous methods
• Key findings include:– Role definition important both for training needs
and for how integrated into health system delivery – Training necessary but not sufficient to translate
knowledge into practice– Motivation key to ensuring ongoing productivity
and quality of CHW performance
Effects of CHW Program Factors on CHW Performance
• Most literature focused on health workforce and service delivery building blocks
• Findings indicate that CHWs: – Expand access to services in resource poor areas– Do not replace the need for facility-based services– Need clearly defined roles and responsibilities – Need an adequate supply chain– Need supportive management and supervision– Should have strong linkages with formal health
system
Effects of Health System Factors on CHW Performance
• Consistent common themes:– Well designed and clearly defined job descriptions– Appropriate pre-service and continuing in-service training– Supportive supervision and constructive feedback– Adequate financial and non-financial incentives– Adequate resources to ensure that CHWs are properly
equipped and supplied – Systematic monitoring and evaluation of CHW performance
• AND: – Support from local and national government– Effective linkages with formal health system
Systematic Reviews Conclusions
Assessment of the Reviewed Literature
• No rigorous evidence on how formal health systems can do better to improve CHW performance
• Very scarce evidence on the role of program design, launch, scale-up and continuous improvement in improving CHW evidence
Yeah, but good luck getting it peer-reviewed
Finally ….
While the tide cannot turn without clinical services;
without the community, clinical services alone cannot turn the tide