Differentiated Service Delivery in Mozambique
Policies on differentiated service delivery (DSD) are due to be integrated into national guidelines in 2017. The national acceleration plan emphasizes the need to enroll more patients on treatment, and emphasizes three DSD models: community adherence support groups, three-month drug distribution, and six-month clinical visit spacing.
There are currently two models being piloted in two provinces, including the family approach (92.1% retention over 24 months) and adolescent adherence clubs (99.1% retention). Results of these pilot projects are expected to inform the forthcoming national guidelines. At a community level, there is a strong influence from civil society and people living with HIV to scale-up DSD through community models.
Mozambique’s Ministry of Health sees community groups, involved in the national technical working group, as a key stakeholder to rolling out DSD. Barriers to scale-up include lack of infrastructure, health resources, and the absence of DSD in national policies. Mozambique plans to: increase community engagement and include people living with HIV in the planning and implementation of strategies; build effective data collection systems; and use impact evaluations from pilot models to guide national standard operating protocols, manuals, and tools for providers and communities.