Contributor:
Selvan Antony, APCOM

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What is Community Based Monitoring (CBM)? 

APCOM, with support from AFAO, developed a guide regarding the implementation of community-based monitoring at the country level for the Sustainability of Key Population Services in Asia (SKPA) Program.

In this guide, CBM is defined as “Community based monitoring is a framework, which is designed, led and driven by key population community and their networks in identified health service delivery facilities to measure the quality of HIV services, document or gather data and report potential challenges affecting the service delivery chain, and assess the stigma and discrimination experienced by key population communities in health care settings. The gathered data can be used to improve the services and hold service providers to account” 

This guide discusses different models/approaches which the key population communities and networks can adopt, to monitor and assess the quality of health services and local conditions in their country. The different models are the following, 

1. Community score card
2. Community feedback and response mechanism
3. Key population beneficiary perception survey 

For more details about the SKPA CBM guide, please click here.

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Bhutan

In June 2020, Save the Children Bhutan conducted a consultation meeting with KP networks and National Stakeholders in Bhutan. This meeting opened up space for participants to walk through the SKPA CBM guide and discuss the rollout plans. 

In this meeting, sixteen participants showed their presence. These were representatives from National HIV/AIDS programs and KP networks; health counselors; outreach workers from health improvement service centers; coordinators from Country Coordinating Mechanisms (CCM); Executive Directors; Programme Officers from SC Bhutan and SKPA Officers—by virtual attendance—from APCOM. 

CBM approaches, tools, and methods were discussed and clarified in the meeting. With the support of SCI Bhutan and APCOM, the KP networks—Rainbow Bhutan and Lhak-Sam—have drafted their CBM rollout plans. Through the CBM survey, Rainbow Bhutan intends to collect health services information/data from KP beneficiary MSM, Transgender, and PLHIV community members.  

CBM survey is set to be rolled out in October 2020. Data or information collected from the KP beneficiary will be transformed into advocacy materials and tools, to strengthen the KP Intervention program in Bhutan. Both AFAO and APCOM will continue to support SCI Bhutan and their KP Networks to roll out CBM work successfully. 

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Mongolia

Together with APCOM and AFAO, Youth for Health kick-started the CBM project by conducting a series of consultation meetings with KP communities and stakeholders in the last quarter of 2019. 

Following the meetings, Youth for Health sketched, and finalized their CBM monitoring tools and CBM operational plan, aligning with the Mongolia context. 

In the first phase of CBM implementation, Youth for Health will reach out to the MSM population who accessed services from the health centers in Mongolia. From June to August 2020, Youth for Health has gathered information/data from 251 respondents through an online survey.

After conducting the data analysis report, Youth for Health will disseminate the key findings or key results to the stakeholders. 

CBM survey key findings will be converted into IEC materials or advocacy tools for effective evidence-based advocacy with stakeholders. It will help them to bring improvement in the quality of HIV services in the KP intervention programme. 

In the second phase of CBM implementation, Youth for Health will collect program-related information from FSW (female sex worker). The data collection activity is set to start from December 2020. APCOM will continue assisting Youth for Health in their CBM work.

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Papua New Guinea

In November 2019, the Burnet Institute introduced the CBM to the Key Population Advocacy Consortium and stakeholders in PNG through consultation meetings. The National Department of Health, UNAIDS, USAID PEPFAR, Centre for Disease Control (CDC), Global Fund Country Coordinating Mechanism (GF CCM), Civil Society Organization (CSO) representatives, members of the Strategic Information Technical Working Group and members of the Key Population Advocacy Consortium participated in sessions.

Within these consultation meetings participants were provided with good clarity on SKPA CBM models. Further more, it ensures that stakeholders understand CBM and provide country-based context for designing and establishing a CBM system for KP advocacy Consortium.

They intend to monitor and collect data on the regularity regarding the supplying ARV commodities to sex workers, MSM, TG and PLHIV community members. Piloting of the data gathering will start from October 2020. 

The gathered data from the survey will be transformed into advocacy material for evidence-based advocacy with stakeholders, such as provincial health management and hospital administrators, to ensure regularity in supplying ARV commodities PLHIV clients form the Sex worker, MSM, TG, PLHIV community members

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Sri Lanka

Family Planning Association of Sri Lanka formed a CBM technical working group (TWG) to receive advise regarding implementing CBM work in Sri Lanka. This group consists of the following members,

”Monitoring of services is important, and this is in no way a complaint mechanism. This must be made clear and aware from the get-go. This is a tool to better our work and the interventions. Additionally, APCOM has great resources linked to building capacity of CSOs, and it would be great if this is also shared during their support in Sri Lanka,”

Niluka Perera Backup Health Initiative says.

1. National STD/AIDS Control Program (NSACP) 
2. KP Services Related Consultant
3. PR I Consultant,
4. PR II Programme Director,
5. SKPA Representative, 
6. KP focal points from the KAP Committee (MSM, FSW, TG, PWID, TSP and PLHIV), and 
7. Backup health initiative representative.

Initially, this CBM TWG met to discuss the CBM project, such as an implementation plan, data collection tools and its importance in Sri Lanka. The TWG suggested adopting two approaches, which is a Community scorecard and a Key Population beneficiary perception survey for gathering HIV program-related data from KP community members. 

At the same time, this group commented that a baseline understanding of services to be carried out after the COVID-19 service delivery environment. This activity will help reflect accurately the current contexts. Furthermore, it will help the TWG to provide constructive feedback for CBM implementation.

The CBM data collection activity will be rolled out soon, whereas gathered data on the HIV program from KP will be converted into advocacy tools. Significant findings from the survey will be shared with the stakeholders to help realign the KP intervention program. 

To expand the scope of this working group, the existing CBM TWG will be replaced by the national level TWG which will provide overall guidance for implementing the HIV prevention program in Sri Lanka. 

“NSACP has always encouraged CSOs and community members to provide feedback either through CSOs or individually. This information lodged will be then taken into consideration during legal and ethical subcommittee discussions. A formalized process for this is a great introduction. NSACP will be taking on most CSOs under their wing by 2021 as a system that monitors not just STD services for community members, but other barriers are needed.”

Dr Satya Herath PR I Consultant Venereologist NSACP.

“We are excited by the work being done to improve HIV services for KP communities and hope this ultimately helps deliver better outcomes for KP communities and others in need. APCOM, as SKPA’s lead technical partner on CBM, has been an instrumental change agent in moving this initiative forward across several of the SKPA countries,” SKPA programs manager Inga Oleksy says.

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“Community-Based Monitoring (CBM) is very new in Laos. But for CHias and me, this project is very exciting. Being a CBM officer under the SKPA project in CHIas, I am learning a lot of new ideas and approaches to conduct CBM work in Laos effectively. The SKPA CBM project has created a space for the community data collectors, such as MSM and Transgender, to strengthen their capacity to conduct outreach work. With support from APCOM and AFAO, CHIas foresees to advocate with potential stakeholders to improve the quality of services in the HIV intervention program,”

Vongphachanh Temmelath (Khom) says.