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

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• 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