Community-centered Clinical Services: Case Studies and Lessons Learned from Implementing Key Population Programs in India

Anjana DasSTI Capacity Building

Scale and Scope of Avahan Program

Programcoverage

• 6 states, 83 districts, 600+ towns• 129 NGOs

• Combined State Population• ~ 300 million

• High risk groups covered• FSW – 221,000• MSM & TG – 81,000• IDU – 18,000• Men at risk – ~5 million

Prevention Package

• Outreach, BCC

• Commodities (condoms, lubricants, needles)

• Clinical services for STIs + counseling

• Referral - TB, HIV testing, ART

• Community mobilization

• Structural Interventions: Local advocacy, police sensitization, crisis response, community advisory committees

10 Years = USD $376 million2004 – 2013Phase 1 – Scale-up 2004-2009Phase 2 – Transition 2009 - 2013

STI service delivery structure

Community Led- Approaches for Clinical Service Provision

Phase 1(2004-2009)

Scale-up

Phase 2(2009-2013)Transition

• Training and supporting peer outreach workers

• Establishing service committees e.g. STI, care and support

• Appointment of community members in clinic staff positions

• Preparing CBOs to lead STI program components

• Service committees increasingly led by community non-peers

Community participation guidelines for planning, implementing and monitoring services in Avahan COGS & CMP

Refined with learnings

Documenting Community-centered Clinical Services: Case Studies and Lessons Learned

Purpose

Intended audience

Case study selection

criteria

• Document innovative approaches used in resource-constrained settings

• Share good practices and lessons learned

• Strengthen capacity of KP programs elsewhere

• Primary: KP program implementers

• Health officials, donors, policy makers

• Replicability and scalability

• Demonstrated improved outcomes

• Relatively simple processes

• Acceptable and accessible by KPs

List of Thematic Areas/Chapters

• Community-led Approaches for Clinical Service Provision

• Customizing STI Service Delivery Models • Sexually Transmitted Infections (STI) Care and

Treatment• Continuum of Care • Clinic Management Systems• Sustainability and Transition

Lessons Learned

Community Participation

Service Delivery Models

STI Care and Treatment

• Increased clinic utilization

• Has the potential to lead to a change from an externally-led to a community-led program

• Tailored to KP typology and local resources

• Improved accessibility

• Static + outreach clinics cost-effective in large urban areas

• Standardized guidelines and SOPs

• Regular quality monitoring and use of data improved services

• POC tests increased syphilis screening

Lessons Learned (2)

Continuum of care

Clinic Management

Systems

Sustainability and Transition

• Demand generation and HTC at outreach clinics led to four-fold increase in HIV testing

• Primary HIV care & support, TB screening provided on-site with referral linkages for higher-level care

• Capacity building mechanisms for clinic staff ensured quality of services

• Stock management systems for drugs and other commodities prevented stock-outs and wastage

• CBOs should be involved in transition planning, post transition support necessary

• Early planning for sustainable mechanisms for clinical services

Acknowledgements andKey References

• Bill & Melinda Gates Foundation

• Implementing agencies• Our community members