Edington Dzinotyiweyi CT Technical Advisor CDC Namibia. S

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The role of community counselors (CC) in
expanding human resources to scale up CT
Namibia Ministry of Health and Social Services
and Centers for Disease Control and Prevention G
lobal AIDS Program Edington Dzinotyiweyi - CT T
echnical Advisor CDC Namibia Sarah Fuller Nati
onal CT Coordinator MoHSS Namibia
Conny Samaria National Coordinator Namibia Red
Cross Lusaka, Zambia January, 2008

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Overview

• Background
• Rationale for using CC
• Strategy
• Deployment
• What do they do?
• Partnerships
• Lessons Learnt
• Challenges
• Key recommendations

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Background - Namibia

• Population 1 991 747
• HIV prevalence rate 19,6 (UN)
• 230,000 PLWHA
• Estimated orphans 85 000
• 35 public hospitals, 33 health centers, 250
  clinics, many outreach posts
  
• 13 regions, 34 health districts
• 17 freestanding NGO VCT centers
• 235 public health facilities with CT services
• 103 public health facilities with HIV rapid
  testing
  

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Rationale for using CC

• Health facilities overburdened with HIV patients
• Need to scale up CT as entry to care support
• Critical shortage of human resources (health
  workers)
  
• CCs are from the community and understand local
  context
  
• Many HIV volunteers eager for employment
• PEPFAR funding available through CDC
• Affordable and sustainable resource (US214 a
  month)
  

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Strategy

• The CC program introduced in 2004
• Aim was to address human resource challenges
• Accomplished through harnessing existing
  affordable resources within communities
  
• CC are non professional cadres drawn from the
  community integrated into formal health care
  settings
  
• Competently trained (12 weeks) deployed to
  health facilities
  

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Deployment of CC

• Clinics, health centers and hospitals with CT
• Antenatal care (ANC)
• Tuberculosis services
• Sexually transmitted infection (STI) clinics
• Antiretroviral therapy (ARV) clinics

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What do they do?

• Pre-test and post-test counseling
• Performing rapid diagnostic testing if certified
• Making appropriate health and social services
  referrals
  
• ART adherence and PWP counseling
• Supportive and ongoing counseling
• Infant feeding counseling and support
• Translation counseling in local languages
  (expatriate health care providers)
  
• Maintaining quality testing and counseling
  records
  

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Partnerships

• Collaboration of different stakeholders
• MoHSS owns program, provides policies
  supervision
  
• USG-PEPFAR Funding technical assistance
• National Institute of Pathology (NIP) HIV rapid
  test training QA review
  
• Regional committees select CC candidates

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Partnerships

• Namibia Red Cross Society employs and provides
  administrative supervision
  
• Secure Health Consultants (local NGO) provides
  training
  
• MoHSS facility-based nurse supervisors provide
  clinical supervision
  

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Lessons Learnt

• Reduced burden of care upon health workers
• Improved health services for people
• Access to CT increased
• Merges local knowledge of support services for
  HIV AIDS with formal health services
  

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Lessons Learnt

• Capacity building skills transfer among
  individuals institutions
  

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Challenges

• RT quality assurance
• Sites and CC certification
• Work related stress
• Prevention counseling needs strengthening

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Key recommendations

• Systems for RT certification QA need
  streamlining
  
• Psychosocial support for CC should be an integral
  part of the program
  
• Prevention counseling training should be expanded
  focusing on PwP
  
• Other countries may benefit from training CCs in
  adherence counseling RT
  
• Need to develop exit strategy

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Thank you!
Community counselor practising rapid testing
during training
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• Thank you