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Basic HIV Course and Basic HIV Course and MobilisationMobilisationToolkit on HIV Prevention, Treatment, Toolkit on HIV Prevention, Treatment, Care and SupportCare and Support
Prevention is Better than Cure
Prathima Naidoo
Health Behaviour Intervention ManagerBroadReach Healthcare
2 December 20095th SAHARA Conference
© 2009 BroadReach Healthcare (Pty)Ltd4
ContentsContents
• About BroadReach Healthcare (BRHC)• Situation Analysis: Status of Health Education and
Community Dialogue• The BRHC Basic HIV Course and Mobilisation Toolkit• Roll-out Strategy• Monitoring and Evaluation • Results up to 30 November 2009• Next Steps
About About BroadReachBroadReach HealthcareHealthcare
© 2009 BroadReach Healthcare (Pty)Ltd6
About About BroadReachBroadReach HealthcareHealthcare
• Global healthcare solutions company• PEPFAR Partner• SA: 4 provinces
• 21 hospitals• 10 CHCs• 128 PHCs
• Key focus in SA:– Health systems strengthening– Capacity building– Health behavioural interventions
• Staff compliment: just over 100
Situation AnalysisSituation AnalysisStatus of HIV Health Education and Community DialogueStatus of HIV Health Education and Community Dialogue
© 2009 BroadReach Healthcare (Pty)Ltd8
Situation Analysis: HIV EducationSituation Analysis: HIV Education
• While much has been accomplished in terms of basic education and information dissemination regarding HIV –recent evidence suggests that there is a decrease in knowledge and the quality of education
• Interviews with district health teams, healthcare professionals and NGOs indicated a need for basic HIV knowledge that is comprehensive and ‘integrated’ –targeted towards volunteer community health workers
• There was a strong need for tools that did not ‘dil ute’messages and which facilitated community dialogue
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Correct Knowledge about Prevention and Correct Knowledge about Prevention and Rejection of MisconceptionsRejection of Misconceptions
• South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, 2008
The BRHC Basic HIV Course and The BRHC Basic HIV Course and Mobilisation ToolkitMobilisation Toolkit
© 2009 BroadReach Healthcare (Pty)Ltd11
Overall AimOverall Aim
• Capacitate and empower community mobilisers to generate open and ‘de-stigmatising’ community dialogue that supports preventative behaviour and promotes early access to care
• Increase the efficacy of government, NGOs, CBOs and other community volunteers to deliver ‘integrated’messages on prevention, treatment, care and support
• Capacitate volunteers and community healthcare workers to implement face-to-face education to scale, using participatory and entertaining methods
• Encourage networking and collaboration between volunteers
© 2009 BroadReach Healthcare (Pty)Ltd12
• The BRHC technical
team consulted
• Healthcare
professionals and
district health staff
health educators,
social mobilisers and
home-based carers
• BRHC observation
and need
assessment
documents
CONSULTATION
CORE REFERENCES
PRE-TESTING
REVIEW/
CLINICAL APPROVAL
• South African
clinical guidelines
and policies
• The Centre for
Disease Control
(CDC)
• The World Health
Organization (WHO)
• UNAIDS
• Thebody.com
• Avert.com
• Piet Retief
• Heidelberg
• Workshop: Piet
Retief technical
team
• 2nd review by BRHC
technical team
• 3rd review by BRHC
clinical team and
Piet Retief team
• External editing and
proofing
• Sign-off on
translations (2
modules) per
district
Development processDevelopment process
SCB LINK
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Target Audiences for the Course and ToolkitTarget Audiences for the Course and Toolkit
Primary AudienceMobilisers with little to
no comprehensive knowledge about HIV
and AIDS who conduct HIV
education in the
community – and have no ‘tools’
Secondary AudienceMobilisers with some
comprehensive
knowledge about HIV and AIDS – where the
curriculum will act
as a refresher course and offer ‘tools’
End RecipientsFamilies/household
Men in work placecommunity at large
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Course and Toolkit ContentCourse and Toolkit Content
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What does the curriculum look likeWhat does the curriculum look like
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Structure of the ModulesStructure of the Modules
• What is the ‘condition’• How do you get it• How to prevent getting it and infecting others • What are the signs and symptoms • What actions to take if you have it • How to treat it • Advantages of knowing if you have it• Benefits of seeking healthcare intervention early• How to benefit from treatment
RollRoll--out Strategyout Strategy
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RollRoll --out Strategy: TOT out Strategy: TOT
300 or more Mobilisers
300 or more Mobilisers
100 or more Mobilisers
2 or 4 Master of MastersTrainers
Mpumalanga: 6 Master Trainers
Gauteng:2 Master Trainers
KZN:6 Master Trainers
Eastern Cape:
6 Master Trainers
300 or more Mobilisers
All Communities in the 4 Districts
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Training Sessions Training Sessions
• TOT held in JHB for all provinces in September 09– 7 Day in-house training– Accommodation and meals provided
• Trainings held in various provinces in October and November– 5 day resident courses– Accommodation and meals provided – Transportation provided by District Health – Allowance of R50 per day for incidentals
© 2009 BroadReach Healthcare (Pty)Ltd20
Innovations in ImplementationInnovations in Implementation
• Roll out at scale: ‘speed of lightening’• Capacitate and utilise existing resources in the
community• Full partnership with district health teams• Method of implementation allows better understanding of
community mobilisation mechanisms to build more ‘involved programming that links the community to healthcare services that is measurable’
• External company to manage logistics and toolkit distribution
Monitoring and EvaluationMonitoring and Evaluation
© 2009 BroadReach Healthcare (Pty)Ltd22
Technology to Monitor and EvaluateTechnology to Monitor and Evaluate
• External company to develop database, capture data and produce reports
• External company to manage payments of all allowances – 1000 bank accounts
• Paper based and WAP enabled cell technology to capture education sessions
• Duplicate ‘paper based’ – posted to one destination with self addressed envelopes
• Signatures of recipients of education• Information captured and reported ‘real-time’ from cells
and district health has access to dashboard
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Mobile AccessibilityMobile Accessibility
• Mobilisers Trained on Project 999 • Number of Data Cards Distributed 970
Results: 12 October Results: 12 October –– 30 November 30 November 20092009
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Mobilization Toolkit projected reachMobilization Toolkit projected reachTotal number of Community members reached after 6 months =
337,500Projected reach in KZN, EC and Mpumalanga = 85,000 each
Projected reach in Gauteng = 82,500
Oct Nov Dec Jan Feb Mar Apr
Master Trainers 4 4
Mobilisers 400 200
(Total) 400 600 600 600 600 600 600
Community 10000 15000 15000 15000 15000 15000
(Total) 10000 25000 40000 55000 70000 85000
Oct Nov Dec Jan Feb Mar Apr
Master Trainers 3 3
Mobilisers 300 300
(Total) 300 600 600 600 600 600 600
Community 7500 15000 15000 15000 15000 15000
(Total) 7500 22500 37500 52500 67500 82500
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Cadres of Cadres of MobilisersMobilisers trainedtrained
Traditional Healers and ward counselors form part of the ‘Other’ category – 3
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Total Education Sessions in Community Total Education Sessions in Community (12 Oct to 30 Nov)(12 Oct to 30 Nov)
• Total number of sessions to date: 5,316
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Where do Education Sessions Take PlaceWhere do Education Sessions Take Place(Summary 12 Oct to 20 Nov)(Summary 12 Oct to 20 Nov)
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Education Topics CoveredEducation Topics Covered(Summary 12 Oct to 30 Nov)(Summary 12 Oct to 30 Nov)
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People Reached per Region People Reached per Region (Summary 12 Oct to 30 Nov)(Summary 12 Oct to 30 Nov)
• Total number of people reached to date: 44,362
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Gender Breakdown of People EducatedGender Breakdown of People Educated(Summary 12 Oct to 30 Nov) (Summary 12 Oct to 30 Nov)
• Average time spent in a session is 42 minutes• Number of condoms distributed 124,235
NEXT STEPS NEXT STEPS
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Next Steps: Beyond EducationNext Steps: Beyond Education
• Extend training of mobilisers and toolkits to include more ward counsellors, spiritual leaders, facility based health promoters and traditional healers
• Implement verbal screening tools for primary prevention for TB, PMTCT, VCT and high risk negatives
• Referral system between community and healthcare facility for those screening ‘positive’ to seek early healthcare intervention – secondary prevention
© 2009 BroadReach Healthcare (Pty)Ltd34
Next Steps: Prevention is Better than CureNext Steps: Prevention is Better than Cure
Encouraging early health seeking behaviours and primary prevention
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Reaching families with integrated education Reaching families with integrated education
Back to Basics
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AcknowledgementsAcknowledgements
• BRHC HBI team, clinical, PM and management
• PEPFAR
• Piet Retief and Heidelberg hospital staff , HBCs and
support groups
• Fleishman-Hillard SA
• Ngikwazi and Avo Vision
• All Master Trainers (they worked tirelessly)
• District Health Teams
© 2009 BroadReach Healthcare (Pty)Ltd37
THANK YOU
• WWW.BRHC.COM
Prathima Naidoo011 482 7596