QUALITY ASSURANCE

Overview:

Through the Emergency Plan, services are being made available for HIV/AIDS prevention (VCT, PMTCT) and treatment ( ART , etc.). As services become more available, it is crucial to ensure these services are both affordable and of good quality to increase client access. Additionally, the quality of interaction between the client and provider needs to be strengthened, as poor interactions with health care workers can be a major impediment to clients who need or want to use these services. Once services have been strengthened, knowledge of when, where and how to access services needs to be increased among the catchment population.

In this context, the HCP quality assurance activities address three specific areas of need, arising in part through the community assessment process: 1) enhancing the quality of counseling for HIV/AIDS related services through training of providers and the development of client and provider job aids, 2) developing the capacity of intermediary groups, such as PLWAs and other lay counselors, to serve as a bridge between the communities and health facilities, and 3), increasing awareness and demand for services among community members. The primary focus of these activities will be in and around the selected community sites, however, certain activities – namely print materials and public service announcements – will have a more extended reach and impact. Therefore quality assurance activities will take place at two levels: at local health facilities within the catchment areas where CAFs have been established, and at a national level by providing prototype communication resources for use by the MOHSS and CDC.

Objectives:

• To reduce the stigma and discrimination that PLWAs experience at health facilities, within their community and at home;
• To improve the counseling and communication skills of health care workers;
• To strengthen the relationship between the community and the health clinics; and
• To increase awareness and use of HIV/AIDS related services.

Audiences: Health care workers, general population and CAFs including PLWAs and their families.

Expanding the use of the HCP Interpersonal Communication (IPC) Curriculum

Results from the community participatory analyses reveal generally poor relationships between community members and health care facilities. Community members state that health care workers have negative attitudes towards clients, resulting in reluctance among clients to use health facilities. Through quality assurance and community participatory assessments, HCP aims to strengthen these relationships and to establish better referral systems between communities and health facilities.

As an initial step to address this problem, HCP developed an Interpersonal Counseling and Communication (IPC/C) curriculum to train health care workers in counseling and communication skills. Health care workers at 5 Mission Hospitals that have started PMTCT services have already been trained. CDC has adapted the curriculum to train health care workers in government PMTCT sites. In FY 05, HCP will support IPC training in both the existing and new sites but with a broader audience. In collaboration with the Ministry of Health and Social Services and CDC, HCP will identify other health care workers to train who are the entry point for referring clients for VCT or PMTCT (e.g., nurses at TB, Family Planning and Ante-natal clinics). HCP will collaborate with a local organization to train community counselors to incorporate the IPC/C curriculum into their training to ensure the quality of counseling is consistent within the health facilities and in the community outreach programs.

Supporting Activities:

Development of Communication Resources

HCP will continue to develop HIV/AIDS, VCT, PMTCT and ART job aids and client materials to ensure that the information and messages that health care workers are giving their clients are accurate and consistent. These materials will be developed with technical input from CDC, MOHSS, community HIV/AIDS organizations, and health care workers themselves. In addition to the print materials, public service announcements will help to educate the public generally on the types of services available.

Increased Involvement of PLWA

HCP will work with local organizations to train PLWAs as patient advocates so they can perform outreach activities that inform, reassure and encourage community members to use VCT, PMTCT and ART services. The CAFs will be responsible for organizing community meetings that bring together health care workers, PLWAs and community members to discuss issues that both experience and ways in which relationships can be improved.

HCP will also provide technical and financial support to a local organization to establish local support groups for people living with HIV. These support groups will provide emotional support, inform members of the importance of treating opportunistic infections, educate members on living positively and provide information about treatment and the importance of adherence.

To reach a broader audience of PLWAs and their families and friends, HCP will produce a radio diary program with a person living with HIV. This radio program will be a personal account of the daily trials and tribulations that a person living with the virus experiences. Through this program standardized information and advice will be passed on to PLWAs, their caregivers and support networks ensuring that those people who are too scared to disclose their status will still receive support, information and advice.