On 20 January 2022, APCOM, in partnership with PEPFAR/USAID/EpiC project and supported by FHI 360, UNAIDS, the Global Fund SKPA project organized a 90-minute webinar on ensuring a mechanism that will improve the quality and access to HIV services for key populations and that the key populations are in the best position to determine what counts as friendly, accessible, quality services, and to evaluate if services meet those expected standards and to propose solutions and ways forward where issues were identified. The webinar had the following objectives:
- Provide a better understanding on how Community-Led Monitoring is being implemented under EpiC and its outcomes;
- Challenges and opportunities from the key population perspective when implementing CLM/CBM (Community-Based Monitoring) at the country level
- Determine the global and regional actors who are supporting the implementation of CLM/CBM at the country level and propose coordination arrangements
- Identify action points in the region and country to ensure that there is meaningful participation by the community in advocacy CLM/CBM sustainability and service delivery improvements
- Recommendations and way forward to coordinate key populations-led CLM/CBM intervention programme at the regional and country levels
32 participants from 10 countries joined on Zoom and a further 184 views on APCOM Facebook Live; Cambodia, India, Indonesia, Ireland, Laos, Myanmar, Nepal, the Philippines, Thailand, and United States.
Link to Resources
“I want to conclude by emphasizing the critical role the CLM and CBM mechanisms can play in this region to ensure provision of services which are AAAQ compliant to key populations and PLHIV. Webinars and meetings like this one will help the communities to overcome the structural barriers to CBM and CLM implementation in national AIDS programmes in Asia Pacific. Governments in this region should recognize the value addition that CLM and CBM programmes can bring to M&E systems of national AIDS programmes. It is the community involvement in the national AIDS response at every level – planning, implementation and monitoring that will be the most important determinant for the success of countries in achieving the SDG targets set for 2025. Without that it will be impossible to reach the ultimate goal of ending AIDS by 2030.”JVR Prasada Rao, APCOM HIV/AIDS Ambassador (and former Union Health Secretary of India and the Special Envoy to the Secretary General of the United Nations on HIV/AIDS for the Asia Pacific region)
Community Led Monitoring is key in bringing key population into services
It is in the best position to have the community determine what is considered a friendly, accessible, quality services. This will ensure that the community will get into services and would not be pushed away and prove more effective than the top-down approach. Along with having services and providers directly accountable to the community will greatly help the improvement of service. This will ensure the coverage of HIV services through out the key population community and ensuring retention rate for the existing clients that are already in the service.
“CLM is vital in PEPFAR’s client centered approach because it puts community’s need and voices in the center of HIV responses through the use of qualitative and quantitative indicators.”Dr. Pimpanitta Saenyakul, HIV Deputy Team Leader, USAID RDMA, Bangkok.
Government Play a Vital Role
Governments in Asia Pacific region should recognize the unique value of community data not just in a public health emergency like Covid-19, but in regular monitoring of programmes targeted towards communities of key populations and people living with HIV. Early engagement with departments of health and top policymakers, and local health service managers should be convinced that CLM is a useful tool for reaching the HIV-related goals and targets. Establishing CLM needs to strike a balance between maintaining standards and avoiding being overburdened by the process. Above all to ensure the AAAQ:
Availability: HIV related services must be available in sufficient quantity and continuous supply. In the Covid-19 context, this assumes importance because of the major disruptions
caused to supply chains because of prolonged lockdowns and suspension of transport services;
Accessibility: HIV services must be accessible to everyone, in terms of physical access, affordability, access to information and non-discrimination. This is the most critical part as we have seen in many cases that even when supplies are abundant, they do not reach the last mile;
Acceptability: HIV services must be acceptable to consumers, culturally appropriate and be sensitive to vulnerable groups. This criterion applies mostly in information services where the cultural appropriate ness plays an important role;
Quality: HIV services must comply with applicable quality standards. This is of paramount importance as a lowering of quality for the key populations or HIV positive people violate the principle of equality and equity.
“In India, national response has been very positive in line with CLM which is based a basic principle of ‘nothing for the community without involvement of the community’ which also one of the statements of one of the officials from the National AIDS Control Organization. This implies how much the government is looking for the involvement of the communities in addressing the response to HIV/AIDS.”Yashwinder Singh, Lead Community System Strengthening, The Humsafar Trust, India
Support needs at the country level
COVID-19 has impacted the efficacy of CLM process
The COVID-19 pandemic and the resulting responses have highlighted the barriers that exist to the collection and flow of data from service users to facilities. It reinforces the need for quality and systematic community data collection and analysis. CLM can be used by communities in humanitarian situations and other challenging environments, and in monitoring related societal and structural interventions or action against stigma and discrimination. The on-going Covid-19 pandemic that has shifted priorities, resources and attention but at the same time there has been a tendency for CLM/CBM to become a bit stuck in debates about processes and toolkit development.
Challenges that facing the CLM program
Implementing the CLM program does not come without challenges; accuracy of data collected, disconnects between formal health systems and community responses which often results in increasing marginalization of the community, lack of sustainable multi-year funding for routine CLM is still a concern since it will be use to evaluate the services of the providers and ensuring this is led and owned by the community.