Kiru, Nigeria—Despite their best efforts, health care providers participating in the Zamfara and Akwa Ibom HIV/AIDS project (ZAIHAP) couldn’t ensure that pregnant women and other at-risk clients would return for follow-up visits and their medication.
Officials leading the Jhpiego-supported project attributed the lack of client follow-up to a critical shortage of health care providers at the 15 participating health facilities. They explained the situation to Alhaji Salisu Kiru, the traditional head of Kiru, where a severe health care worker shortage existed. In most developing countries, including Nigeria, more than 90 percent of health care providers work in urban areas even though over 70 percent of their population lives in rural areas.
Kiru, the traditional leader, had a brilliant idea: “Why don’t I select some community retired health care workers and volunteers for you to train . . . to support your program? They are my people and I know a few of them who will be willing to do this for us and I will select them myself.”
Integrating community health volunteers with ZAIHAP’s efforts has had a profound impact on referral rates. The percentage of clients who return for follow-up counseling, testing and treatment has increased from less than 20 percent to 93 percent, according to project statistics. This unique partnership with retired health care workers is an innovative way to respond to gaps in the health workforce.
The main role of the community health volunteer is to track ZAIHAP clients for their follow-up visits at the facilities to ensure they receive counseling and testing and their medication. The volunteers selected were mostly people with previous training and backgrounds in health-related services and hospital functions. Some are retired health care providers, while others are people living with HIV.
As a result of their prior work and life experience, the volunteers are able to provide community- and some form of facility-based services to women to prevent the transmission of HIV from mother to child. They support house-to-house counseling and discussion of HIV/AIDS issues in an effort to increase use of HIV services; help support HIV counseling and testing; provide additional psychosocial support and counseling to HIV-positive clients; carry out ongoing counseling to the HIV-positive pregnant women who are accessing antiretroviral (ARV) prophylaxis or treatment; and track clients who have not returned for follow-up and accompany them back to the facilities.
“This very successful and unique approach has really helped ZAIHAP, which is funded by the U.S. Centers for Disease Control and Prevention (CDC), to achieve and exceed many important aspects of the project targets,” says Emmanuel Otolorin, Jhpiego’s Country Director in Nigeria.
Of the fewer than 20 percent of clients who came for follow-up at referral sites before the community volunteer program began, only 42 percent provided the feedback necessary to ensure the HIV continuum of care between facility and community is maintained.
This continuum is important because of the intensive, ongoing care needed by people living with HIV/AIDS, but it relies on trust and mutual respect between provider and client. Asking clients how they feel about the services they’ve received helps to strengthen this relationship.
The increase in follow-up rates to 93 percent, since the program was implemented, has been attributed in large part to the efforts of the ZAIHAP’s community volunteers. The volunteer escort and educational services seem to have made clients more comfortable talking to health care providers, as the percentage of people who provide feedback during their referral increased from 42 percent to 96 percent.
This simple initiative has proven to be a very valuable addition to the continuum of care in HIV program implementation. It has expanded the pool of skilled, capable Nigerians who can help care for their own people and showcased an innovative way to build up the health workforce.
Said one community volunteer in Kano: “I thank God I was trained to be part of this team, contributing my little bit to help my people always gladdens my heart. I will be willing to do more even if I have to spend my personal money. . . . I never thought people could ever value or appreciate me this much in my community.”
Jhpiego was awarded the project in 2008, with the overall goal to establish sustainable approaches for the reduction of morbidity and mortality due to HIV/AIDS among vulnerable groups. Among ZAIHAP’s notable achievements so far:
- Trained more than 150 different cadres of health care workers and 35 community volunteers on different aspects of HIV management and health system strengthening, as well as counseled and tested more than 70,000 clients;
- Provided ARV prophylaxis to over 200 HIV-positive pregnant women and 50 exposed babies, and linked up over 300, non-pregnant HIV-positive clients to other comprehensive treatment sites where they could access further care and management in order to maintain the HIV continuum of care;
- Collaborated with National HIV/AIDS and STI Control Program (NASCP) at the federal level and State Agencies for the Control of AIDS (SACA) at the state level to help strengthen government responses to the HIV epidemic; and
- Participated with other partners to develop and update national- and state-level guidelines and Standard Operating Procedures, as well as other relevant documents, to guide the implementation of HIV programming in Nigeria.
Jhpiego was also able to integrate this CDC-funded project with the Jhpiego-led and U.S. Agency for International Development-funded Maternal and Child Health Integrated Program (MCHIP) in all 15 sites—and has the capacity to bring prevention of mother-to-child transmission (PMTCT) services to 40 more such sites that are still without PMTCT services in the three northern Nigerian states of Kano, Zamfara and Akwa Ibom.