Kibilizi District Health Partnership Child Survival Programme (CSP)

In 2001 as part of a Child Survival Programme, Concern Worldwide Rwanda in partnership with Kibilizi Health District launched the PMCT services, the first in country to be integrated into a rural health facility. The Child Survival Programme (CSP) funded by USAID was designed to improve the health status of Kibilizi District through capacity building for high quality and sustainable health services and by empowering communities for better health with locally available resources. Focal interventions include: HIV&AIDS, nutrition, malaria, maternal and newborn care. The goal of the CSP is to contribute to a sustainable reduction in maternal and child mortality and morbidity and to increase life expectancy for 75,000 women of reproductive age and children under-five year in Kibilizi now Gisagara District.

Beside the PMCT activities, the CSP implemented two innovative approaches to increase the access and utilization of HIV voluntary test and counselling services to the most vulnerable living in rural community:

1. Outreach VCT Campaign

The PMCT centre started in Kansi Health Centre, and then had been extended to three other rural health centres in Gisagara District: Kibayi, Kigembe and Kibilizi. In addition, the Child Survival Programme assisted the Health District in implementing and monitoring fixed VCT sites and an annual VCT campaign. The community mobilisation and participation are credited to the involvement of health centre staff, the health volunteers and associations of people living with HIV&AIDS. During the first campaign 921 vulnerable people had been tested and among them 9.5% were HIV positive. The objective is to reach 1,000 people during the second campaign planned in 2006.

According to the CSP-M&E Officer in 8 days campaign the programme reached nearly as many people who came to the VCT fixed sites for testing in a year. For this event the cost of testing had been reduced from 50 cents to less than 10 cents. Outreach made it easier for widows, school-aged youth, and even infants to come out for testing whereas they wouldn’t feel as comfortable, couldn’t afford or didn’t have time to come all the way to the clinics. “I’m amazed to see so many people coming for the outreach counselling and testing. While we couldn’t serve everyone who came this time, we know the demand is there to support future campaigns”. Dr Patrick Migambi, Kibilizi District Health Medical Officer.

“I’m a student in the fourth grade. Both my parents died a long time ago and I want to make sure that I’m okay”, proclaimed a 12-years old girl, barefoot wearing a paper thin t-shirt with a nervous smile as she awaited her turn to be seen by a counsellor.

“My husband recently informed me that he’s positive and he encouraged me to come and be tested” stated a graceful 35 year old woman who had travelled 15 kilometres to a testing site in Mugombwa.

The outreach VCT combined with fixed services is a relevant approach to increase access to the most vulnerable persons. From 2001 to 2004, one year before the phase-out, 3727 pregnant women out of 4201 that attended antenatal care services had been tested and 8.6% were HIV positive. During the same period 113 out of them (35%) received Nevirapine. In addition, 7313 people (3548 men, 3765 females) benefited of voluntary counselling and testing service provided by the Health Centres. The CSP had successfully extended the access and utilisation of voluntary test and counselling to vulnerable rural persons with very limited access to these services.

2. Association-based follow up of HIV positive people

Each of the 7 public and private health centres in Gisagara District supported the creation of an association of people living with HIV&AIDS. The association purpose is to promote positive living among members and also to contribute in positive behaviour change within their community. The members have regular information sharing meeting, give testimonies while participating in CSP’s community education. The health staff provides training and guidance on nutrition and health issues. The associations received a small grant from Concern Worldwide to start income generating activities that allowed facing burden such as: paying transport fees while referred to hospital, buying drugs for opportunistic infections and buying food. The types of activities undertaken include:

• Growing vegetables and potatoes
• Running restaurant
• Rearing small livestock
• Hand-crafting and the use of sewing machine
• Small shop & canteen running (See picture below).

The linkage of health centres with associations of people living with HIV&AIDS, community health workers increased the ownership and potential of sustainability of the impact. The active involvement of people living with HIV&AIDS contribute to reduce AIDS related stigma and to increase community’s sympathy and support toward the infected and affected persons.

References:
Annual reports Child Survival Programme; Kibilizi District Health Partnership; Concern Worldwide Rwanda

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