SKPA-2 CLM Pilot Projects: Improving Availability, Accessibility, Acceptability, and Quality of HIV services for Key Populations

Contributor:
Abhina Aher 
Human Rights, Gender and Sustainable Programming Officer 
APCOM Foundation 

---

Community-led Monitoring (CLM) is essential to community engagement in HIV program delivery. It involves activities carried out by community-based or community-led key population organizations and community members to assess the quality, availability, accessibility, and acceptability of the HIV services they receive. CLM is an ongoing process in which service users or local communities gather, analyze, and use information to support quality improvement of HIV services and advocacy efforts to increase uptake of and retention in HIV and related health services and, ultimately, to improve health outcomes for key populations. Improvements in HIV services for key populations are expected to increase the uptake of and retention of HIV services, leading to improvements in health and life expectancy. By improving uptake of and retention in HIV services, CLM can also help countries to achieve their 95-95-95 targets.

SKPA-2 regional  multi-country grant project funded by The Global Fund with extensive work in Mongolia, Sri Lanka, Bhutan, and the Philippines. The program is focused on accelerating financial sustainability, improving strategic information availability and use, promoting programmatic sustainability and removing human rights & gender related barriers to services. The project is implemented by Health Equity Matters in collaboration with country and regional partners, including APCOM & ICWAP. SKPA-2 is focused on improving the quality of healthcare & HIV services, reducing the healthcare stigma, and improving access to the HIV services among key populations. The project uses the unique CLM framework focus on HIV service provision and based on the Availability, Accessibility, Acceptability, Quality (AAAQ) framework to improve the HIV service uptake among key populations.

Currently, as part of the SKPA-2, the project has successfully completed ‘pilot phase’ for CLM, which focused on piloting a new Toolkit, “SUSTAINABLE COMMUNITY-LED MONITORING OF HIV SERVICES: A Toolkit for Key Populations Toolkit for Key Populations”. 

The pilot program took place in Bhutan, Mongolia and Sri Lanka and along with the process, data collection was completed through two forms; 

1. CLM client form that was available and completed by key populations who accessed HIV services  
2. CLM Serious Incident Follow-up form: this data was collected only from those who noted a serious incident that required follow-up along with informed consent that they all for further follow-up and potential resolution and referrals to relevant services. 

The focus of the pilot phase was to understand and pilot the overall SKPA-2 CLM framework, data collection mechanisms, analyze collected data, use data for the programmatic improvements, help guide advocacy priorities and create stronger mechanism for ‘serious case management’ for the cases reported by the key populations related to a number of potential incidents including stigma, discrimination, harassment and others that are outlined and defined by the toolkit. 

In the pilot phase some of the recommendations included:

1. Holistic health response needs for the key populations;
2. Increase awareness on CLM & simplified process for CLM to ensure uptake and sustainability;
3. Improve understanding among the healthcare workers regarding CLM for greater support & acceptance;
4. Improve awareness on CLM among the key population community members;
5. Build capacity among key population organizations on human rights & gender;
6. Create stronger linkages and mechanisms to manage the serious case incidents in each country and map and review the quality of referrals;
7. Ensure SoPs and training highlight the need for high levels of confidentiality & the need to ensure informed consent;
8. Create sustainable low-cost approach towards the CLM initiatives & improve the knowledge CLM knowledge in the local language;
9. Build stronger advocacy plans and high-level policy reform towards reducing stigma towards key populations when accessing health services. 

Based on the pilot phase learnings, SKPA-2 project is now focusing on simplifying the CLM tools for more greater acceptance and utility among key populations,  streamlining & strengthening forums for the ‘serious case management’, ‘digitalization’ of the CLM forms and data to ensure real-time reporting and immediate implementation for course corrections to improve HIV service delivery and create quality healthcare in SKPA-2 countries. 

Special thanks to our amazing country partners Save The Children from Bhutan, Family Planning Association from Sri Lanka, and Youth for Health Center from Mongolia who have been implementing CLM with their best abilities in collaboration with the HRG community in SKPA-2 countries. We see clear connections between CLM, advocacy, and the Human Rights and Gender workstream, and as APCOM & ICWAP who are the regional sub recipients we are committed to bringing stronger human rights, advocacy, and gender response to create more robust & meaningful response towards CLM activities in the region. APCOM & ICWAP is part of the larger seven alliance CLM regional work in Asia Pacific with other key population networks working in the region and hoping to bring synergy around CLM indicators and greater CLM cross-country learnings in the future to make the CLM response richer and effective for the community work in the region. 

---

---