Perspectives on Differentiated Service Delivery – Dr. Nomthi Lukhele: “CQUIN Helps Us Keep an Open Mind”

Jan 30, 2018

Dr. Nomthandazo “Nomthi” Lukhele is the national ART coordinator for Swaziland’s National AIDS Programme (SNAP) at the country’s Ministry of Health. Dr. Lukhele spoke with us about how differentiated service delivery (DSD) is changing the HIV care and treatment landscape in Swaziland, and about CQUIN’s role in helping SNAP explore new approaches to one of their top priorities: monitoring and evaluation (M&E).

How does your work as the national ART coordinator for SNAP relate to DSD?

I coordinate care and treatment services. Once a client tests positive for HIV, I ensure that they have all the support they need so they can access care and live a quality life. Much of what I do is about patient satisfaction, which is one of the ultimate goals of DSD. It’s also important that, as a country, we achieve and sustain the 90-90-90 goals, including retention and viral load suppression.

Why is DSD important for Swaziland?

Differentiated service delivery has helped us realize that no client is the same. We need different packages of care for patients at every stage of the disease. The new ART service delivery model has come in handy. It’s helped us decongest sites to allow care to be focused on the clients who are most in need of service, and allow more of them to access care. If you look at the way our program is structured, we’ve tried to decentralize care—from hospitals to facilities—but we know ART patients are there for life. The fact is, if we don’t do anything, we will continue to accumulate patients and the system will not be able to cope with the volume.

Differentiated service delivery and the guidance around it are allowing us to share work with communities. It’s providing us an opportunity to empower stable clients—to make them responsible for their own care and to demand the services they need. There is a real opportunity to form a positive relationship with the clients. It’s also an opportunity for us to think through care for unstable clients and those presenting late. We are now thinking of ways to improve retention.

What do you hope to see with regards to DSD in the next few years?

We want packages for all the ART clients (for stable and unstable clients). We want to implement the ART delivery models for stable clients correctly, with all of the necessary resources and support. We also need strong M&E systems to keep us on track so that over the next few years we can monitor progress and attainment of the 90-90-90 targets.

What are some of your unanswered questions about DSD?

Will we still achieve our program targets? The ART program is doing well now with somewhat good ART coverage, retention rates and clinical outcomes, but we’re curious to see if DSD will improve and sustain our current performance and move us closer to achieving what we want, without compromising quality. We’re especially curious about the package for stable clients. We have yet to learn how to effectively implement DSD and all its benefits.

What are some challenges you have faced in this work?

There are many priorities at the Ministry of Health. The challenge is getting all of the resources you need to make something work. We feel at the Ministry that we are short-staffed. Differentiated service delivery is new, and it needs to be well integrated with supervision. When you start a new intervention, you need to work with people and support the intervention. We need to monitor everything to make sure it works. CQUIN has seconded a full-time DSD coordinator to SNAP, and I am confident that this will make a big difference.

How do you see the CQUIN network helping you and your colleagues scale-up DSD in Swaziland?

It’s nice to see that there are others working on this and that there’s support. For us, a priority is strengthening our M&E systems. With CQUIN, we now have a network where we can pose a question so people can share what they’ve done to help guide us along. If people are actively engaged to support each other, we will learn. We need to come up with our own version of this network in Swaziland, so that even within our country, we can learn from those opportunities. It’s going to be critical for us to learn from implementers or facilities, and to have active discussions.

Knowing people are at the same place as you is encouraging. CQUIN helps to keep an open mind about innovations in DSD and all of the possibilities, instead of just staying huddled in our corner. A good example is with M&E. We are now seeing that we can do quick, routine studies instead of things that require a heavier lift. We see that health care workers are bringing tablets and other technologies to the community. This broadens our thinking, and we’ll consider prioritizing that moving forward.

This interview is part of the series: Perspectives on Differentiated Service Delivery, exploring expert views and insights into the importance of differentiated service delivery in sub-Saharan Africa, and the unique challenges they face in advancing services for people living with HIV. For more updates on this series, and other network activities, sign up for our monthly newsletter.

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