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Country Profiles |
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Adherence Support Workers Fill Gaps and Help to Close a Circle |
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The funding allocated enabled the project to train and deploy volunteer adherence support workers (ASWs) at all health facilities where ZPCT supports antiretroviral treatment services—a total of 52 facilities, as of June 2007. Staff from the ZPCT Technical Services Division and FHI's Care and Treatment Division (CTD) developed training materials, worked out details of the program, and supported the training courses, including participants' transportation and meals, working in partnership with Zambia's Ministry of Health at national, provincial, district, and facility levels. A transformative training program And ZPCT staff also knew that trained ASWs would do more than support their clients' adherence to treatment. If the ASWs were based within the health facilities and integrated into their staff, this would facilitate crucial connections between the facilities and the communities where the ASWs lived. The ASW training program might become transformative: it promised to foster a single, expanded circle of care and treatment, rather than adding a loop of home-based, community care that would be a satellite or appendage of the health facility. And, because people living with AIDS (PLHA) were the priority for recruitment as ASWs, the program stood to cement other, important connections by giving PLHA a vital and rewarding role in the day-to-day operations of the health facilities. The training, in practice The training course, developed collaboratively by ZPCT and CTD staff, reflected these objectives. As well as providing a wealth of information on counseling and communication and on HIV and AIDS care and treatment, course materials helped ASWs participate in referral networks; work alongside nurses and doctors as part of a clinical team; and interact with patients in clinical, community, and home settings. Participatory methodologies, practical hands-on approaches, role plays, exercises, and small-group discussions were built into the course materials to help attain these objectives. Staff of the health facilities selected candidates for this training, and none had trouble doing so. Up to four ASWs would be deployed in each facility—all were PLHA, and nearly all were on antiretroviral therapy. A questionnaire ascertains how much candidates for training know before the course starts. Participants are also tested at the end of their training, which is delivered by experienced facilitators and clinical staff. During the course, trainees visit nearby health facilities, and they return to their home facilities for practicums. Each training graduate receives a certificate and a badge. The ASW's work and accomplishments The ASWs are volunteers—the only payment they receive is a transportation stipend, which amounts to 100,000 kwacha (about US$25) per month. These payments are arranged through subagreements with district health authorities, not directly with the health facilities. The ASWs provide extraordinary value for these modest expenditures. According to one report, they have relieved a considerable burden from homecare workers, and they have become "absolutely critical to facilities' ability to maintain increasing numbers of treatment clients and track defaulters." And most ASWs put in more than the required 20 hours; they are committed to the work and find it extremely gratifying. Their clients often share concerns or describe symptoms that they haven't yet disclosed to medical staff. And the ASWs realize that their contributions—in a patient's own language and rooted in local culture—improve patient adherence, knowledge, and understanding. Expanding beyond Zambia Those who want to pursue this innovative training program do not need to wait for a mail delivery: all the materials can be accessed here, at the click of a button, with no waiting for downloads! PHOTOS: (Top) Loveness Mwanga Ntalasha attended a one-week ASW training course in June 2006 in Mansa, Luapula Province. (Middle) The ASW training course in session. Materials in use include a PowerPoint presentation and two manuals, all of which are available by download. (Bottom) From left, ASWs Elizabeth Chama and Gertrude Mwape have a lively discussion with facilitator Flora Hainde in a small-group breakout session. (Photos by Shira Rhodes) – Hilary Russell |
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AUGUST 2007 — When USAID informed staff of the Zambia Prevention, Care and Treatment Partnership (ZPCT) in 2005 that supplemental funding from the Office of the US Global AIDS Coordinator might be available to the project, there was no debate about the best use for the funds. Everyone agreed that the most urgent need was to address the critical shortage of healthcare workers by training community volunteers to help patients on antiretroviral drugs adhere to treatment, thus relieving overworked clinical staff. This was the best way to advance the mission of this FHI-managed, six-year collaboration between the Republic of Zambia and the US Government—to strengthen and expand HIV and AIDS services in five provinces.
On their return to their home facilities, ASWs work in rotation, each about 20 hours a week. They spend two days in a health facility and the third day in a nearby community, where they visit patients to support their adherence to treatment and track down treatment defaulters and try to re-engage them. To facilitate this work, ZPCT has purchased one or two bicycles per health facility for the ASWs to share.