From July 12 to 14, 2022, CQUIN supported a country-to-country visit to Uganda by teams from Ghana and Burundi who learned about community-based differentiated service delivery (DSD) model implementation. Both countries are interested in implementing and scaling up community-based models. The focus of the Ghana and Burundi Ministries of Health (MOH) representatives was to understand how Uganda’s MOH executed its community-based health programs for recipients of care in the context of a high HIV stigma environment.

“A major implementation challenge for the Ghana Ministry of Health is the degree of stigma, especially self-stigma, among clients living with HIV,” said Raphael Adu-Gyamfi, MD, program officer for Pediatric and Adolescent HIV with Ghana’s National AIDS/STI Control Program and DSD focal person. “We hoped the learning visit would illustrate how the model works – and it did. Uganda seems to have removed the barriers posed by stigma through extensive community engagement,” Dr. Adu-Gyamfi added.

For the Burundi team, the visit was a second opportunity to learn about community-based model implementation after a visit to Côte d’Ivoire in October 2021 on the same subject.

Uganda’s National AIDS Control Program (NACP) hosted the visiting countries and organized a series of meetings that included a presentation on the background of community-based models in Uganda, coverage, and implementation strategies, including screening, recipient of care enrolment, and service quality. The visiting teams also learned about Uganda’s monitoring and evaluation system, data, and reporting tools, DSD dashboard use, and antiretroviral (ART) supply chain and logistics management for the community-based models.

The Uganda NACP also organized field visits to four program sites, including a community pharmacy, a clinic supported by an implementing partner, and a main referral health center – the Kawaala HC III health care center that services an average of 200 patients a day in Uganda’s Kampala district. During the field visits, the Burundi and Ghana teams observed how the various health facilities collaborate to improve client care and engagement.

“Our observation of Uganda’s community-based DSD model shows a robust peer-led approach. These peer leaders have been trained in HIV service provision and double as community advocates who refer and encourage recipients of care to opt-in to community-based care. As a result, in Uganda, we see more patients are empowered to pick up their ART from community-based facilities with minimal visits to health centers,” said Violet Oramisi, MBChB, MSc, CQUIN regional strategic information advisor.

The visiting teams reported that the trip was an invigorating experience. “The most interesting highlight from the visit to Uganda was how the recipients of care drove the success of the community-based DSD interventions. This was evident in how they were involved in the planning and roll-out of the interventions, being part of oversight committees, being used as expert clients, and determining which model they would like to be part of,” said Dr. Adu-Gyamfi.

Ghana intends to adopt and adapt the lessons learned from Uganda to begin the implementation of its own community-based model.

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