In Niamey, Niger. Community-based peer educators, known as “Mediatrices” develop their outreach and education plans focused on preventing HIV and supporting those living with HIV.
The recent 2023 World AIDS Day Report from UNAIDS argues that well-resourced community leadership is vital to preventing and treating HIV globally. The report is a stark reminder of how leadership within communities is vital to ending HIV as an epidemic.
This year's World AIDS Day theme, Let Communities Lead, reiterates the importance of localising the response to HIV – enabling community leaders, local civil society organisations and local private sector partners to co-design and lead HIV/AIDS prevention and care programs that address their unique challenges and context.
In honour of this year’s theme, we went directly to some of our local teams around the world to ask them what leading locally means to them.
In Tanzania, through the USAID-funded Data.FI project, which helps countries strengthen routine health information systems, Palladium works with Council Health Management Teams and other local stakeholders to identify health facility-level strategies that accelerate progress toward HIV goals through data review and action planning in “situation rooms”. These ‘rooms’ include technology-enabled interactive dashboards to inform program actions and allow participants to identify any inefficiencies and quickly course-correct where needed.
This has led to impressive improvements in patient outcomes, including an increase in the documented proportion of pregnant and breastfeeding women who are virally suppressed from 74-89% across the nine councils where we worked. The situation rooms, although initiated with Data.FI support, were locally-led from the start, with national government setting standards and providing mentorship to councils.
Now, Data.FI has fully transitioned the process to Council Health Management Teams. Building local capacity and enabling local teams to critically assess and act on their unique challenges, priorities and resources has created accountability and sustainability.
“To me, the ‘Let communities lead’ theme emphasises the importance of ‘involving’ and ‘empowering’ more and ‘prescribing’ less,” says Stella Mujaya, Country Director for Data.FI/Tanzania. “This approach takes into consideration that locals are really the frontline active partners in the design and implementation of the initiative; local leadership promotes inclusivity and sustainability and ensures cultural relevance.”
In Niger, Palladium collaborates with Global Fund to Fight AIDS, TB, and Malaria to strengthen Niger’s network of people living with HIV (RENIP+), to improve their outreach work through setting targets, performance metrics, standard protocols, and referral systems for those living with HIV.
With Palladium mentorship, RENIP+ is training psychosocial counsellors (APS) to support people living with HIV by helping to identify those that may have fallen out of care and helping them re-engage in treatment. The team also partners with a local organisation, SongES, to improve the impact of community-based women peer educators, through training and standardised information sharing on HIV prevention for vulnerable women and girls, and improved documentation of their outreach.
“One day, a 23-year-old girl came to us crying, and I approached her to ask why. She told me that she had been chased out of her home because her aunt had discovered that she was HIV-positive, so we went to her house and I met her,” shares Yacouba Sahabi, RENIP+ Supervisor for Tahoua Region. “I did everything I could but the aunt refused to let her stay at home. So, I took the girl to the hospital and explained the problem to the doctor in charge. During her stay I asked the APS to visit her and assist her. In the meantime, I went to her aunt's house every day to raise her awareness. After 8 days, the aunt agreed to receive her at home: this is the role that the APS play even outside the health facilities.”
Providing communities with foundational tools and skills to take the lead in the work we implement is essential for crafting sustainable solutions. “While the challenges we face may be global in scope, the nuanced answers often lie within local contexts. By placing decision-making and action in the hands of communities, we honor their unique insights, values, and needs,” says Ron MacInnis, Technical Director for HIV at Palladium.
As a lead on the Global Fund CCM Strengthening project, Palladium provides management and technical support to communities across South America, Asia, and Sub-Saharan Africa, by providing them with the means to actively participate in health governance. The CCMs – country coordinating mechanisms - are national bodies that coordinate and oversee all grants from the Global Fund for HIV, TB, and Malaria. “Our support allows community leaders to have meaningful, inclusive, and active participation in planning and oversight,” adds MacInnis. “This includes ensuring community perspectives and skills are incorporated into grant implementation.”
Community empowerment and leadership approaches not only ensure solutions tailored to specific circumstances; they engender a sense of community ownership and commitment. “When communities lead the initiatives we help co-design, they are more likely to be enduring and effective, as they draw upon local knowledge, resources, and networks,” explains Hanna Tessema, Senior Monitoring & Evaluation Advisor at Palladium.
The leadership powerfully demonstrated by communities in the context of HIV will be equally important in the global push for sustaining HIV epidemic control as well as in reaching our global goals to ensure all people, regardless of where they live, have access to good-quality, people-centred universal health coverage and improved primary health care for all.
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