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Community-centered Clinical Services: Case Studies and Lessons Learned from Implementing Key Population Programs in India. Anjana Das STI Capacity Building. Scale and Scope of Avahan Program. 10 Years = USD $376 million 2004 – 2013 Phase 1 – Scale-up 2004-2009

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Community-centered Clinical Services: Case Studies and Lessons Learned from Implementing Key Population Programs in India

Anjana Das

STI Capacity Building

scale and scope of avahan program
Scale and Scope of Avahan Program

10 Years = USD $376 million

2004 – 2013

Phase 1 – Scale-up 2004-2009

Phase 2 – Transition 2009 - 2013

community led approaches for clinical service provision
Community Led- Approaches for Clinical Service Provision

Community participation guidelines for planning, implementing and monitoring services in Avahan COGS & CMP

  • Training and supporting peer outreach workers
  • Establishing service committees e.g. STI, care and support
  • Appointment of community members in clinic staff positions

Phase 1

(2004-2009)

Scale-up

Refined with learnings

  • Preparing CBOs to lead STI program components
  • Service committees increasingly led by community non-peers

Phase 2

(2009-2013)

Transition

documenting community centered clinical services case studies and lessons learned
Documenting Community-centered Clinical Services: Case Studies and Lessons Learned
  • Document innovative approaches used in resource-constrained settings
  • Share good practices and lessons learned
  • Strengthen capacity of KP programs elsewhere

Purpose

Intended audience

  • Primary: KP program implementers
  • Health officials, donors, policy makers
  • Replicability and scalability
  • Demonstrated improved outcomes
  • Relatively simple processes
  • Acceptable and accessible by KPs

Case study selection criteria

list of thematic areas chapters
List of Thematic Areas/Chapters
  • Community-led Approaches for Clinical Service Provision
  • Customizing STI Service Delivery Models
  • Sexually Transmitted Infections (STI) Care and Treatment
  • Continuum of Care
  • Clinic Management Systems
  • Sustainability and Transition
lessons learned
Lessons Learned
  • Increased clinic utilization
  • Has the potential to lead to a change from an externally-led to a community-led program

Community Participation

Service Delivery Models

  • Tailored to KP typology and local resources
  • Improved accessibility
  • Static + outreach clinics cost-effective in large urban areas
  • Standardized guidelines and SOPs
  • Regular quality monitoring and use of data improved services
  • POC tests increased syphilis screening

STI Care and Treatment

lessons learned 2
Lessons Learned (2)
  • Demand generation and HTC at outreach clinics led to four-fold increase in HIV testing
  • Primary HIV care & support, TB screening provided on-site with referral linkages for higher-level care

Continuum of care

  • Capacity building mechanisms for clinic staff ensured quality of services
  • Stock management systems for drugs and other commodities prevented stock-outs and wastage

Clinic Management Systems

  • CBOs should be involved in transition planning, post transition support necessary
  • Early planning for sustainable mechanisms for clinical services

Sustainability and Transition

acknowledgements and key references
Acknowledgements andKey References
  • Bill & Melinda Gates Foundation
  • Implementing agencies
  • Our community members