2023 CQUIN Member Country DSD Self-Assessments Show Marked Improvements

When Cameroon’s national HIV program conducted a self-assessment of its differentiated service delivery (DSD) implementation in 2022, the Ministry of Health-led team determined that several of the 19 domains in CQUIN’s Capability Maturity Model (CMM) for Differentiated HIV Treatment needed close attention. This commitment to improving DSD coverage, quality, and impact led to a highly successful year, and in 2023, the country saw increased maturity and improved performance in 14 of 19 domains on the capability maturity model.

“The clear improvement in 14 out of 19 DSD domains reflects the combined efforts of our technical departments at the Ministry of Public Health, National AIDS Control Committee, donors, technical, financial, and implementing partners,” said Carmen Babodo, MD, DSD focal person at Cameroon’s National AIDS Committee. “We also received increasing requests from Cameroon’s National Association of People Living with HIV to consider more client-centered interventions. The country also benefited from the Global Fund’s DSD strategic initiative with technical support from the WHO and other implementing partners,” she added.

The 2023 DSD capability maturity model results, which were the focus of CQUIN’s 7th Annual meeting, showed that Cameroon achieved a dark green score in four domains – policy, operational guidance, coordination, and procurement and stock management, indicating they had reached the highest level of maturity on the CMM.

Other countries also made notable improvements, including Liberia, which improved ten domains between 2022 and 2023. “It took us close to six months of continuous stakeholder engagement to understand and create the pathway to achieving our current DSD implementation results,” said Amos Mulbah, BS, national DSD coordinator for Liberia. “We regularized our stakeholder meetings and engagement, allowing us to make concentrated efforts to improve specific domains, and our implementing partners were instrumental to our progress.”

However, there were also shared challenges. Overall, countries self-staging results found the lowest levels of maturity in advanced HIV disease management, services for key populations, TB/HIV, integration of maternal child health and family planning services, quality, and impact.

“When you look across all countries, there have been aggregate improvements across all domains from 2022 to 2023,” said Karam Sachathep, PhD, ICAP’s senior strategic information manager. “However, individual country progress varies; some countries have even shown minor regression over the past year.” Countries like Nigeria, for instance, showed mixed results. “In some domains like policy, we were at dark green last year. This year, we are light green,” said Eleen Ekanem, MD, DSD Coordinator for Nigeria, referring to CQUIN’s color-coded system of showing maturity across DSD domains. “We had to do a deep dive into our DSD assessment by working with the CQUIN team to fully understand the capability maturity model questionnaire so we could be more precise with our scoring to achieve our set objectives for DSD implementation.”

“For next year, we want to strengthen and scale up our key population and FP/HIV integration targets to the national level,” said Dr. Ekanem.

“We are committed to strengthening the capacity of providers at HIV care sites and community actors on DSD. We also want to introduce DSD indicators into our electronic reporting system, DHIS2, intensify FP/HIV and NCD/HIV integration, and strengthen data collection on advanced HIV disease,” said Dr. Babodo from Cameroon.

Countries showcased and discussed their results and plans for improvement at the CQUIN annual meeting, including country update sessions, pre-recorded presentations, and poster presentations.