Jamra primary scholl for children affected by HIV/AIDS, drugs or poverty, Senegal (c) Nell Freeman/Alliance Participants in the Photovioce project, Ecuador © Marcela Nievas for the Alliance
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Providing mobile outreach and voluntary HIV counselling and testing services in Zambia

24
SEP
2007

Aids Alliance

In a region where access to HIV services is extremely limited, the Kalomo Mumuni centre is bringing mobile HIV services to a remote area of Zambia. This extended case study brings to life the unique work of Kalomo Mumuni.

The Kalomo Mumuni Centre in Kalomo, Zambia, is attracting a large clientele. While clients may complain about the long queues, the centre’s popularity among residents of the Kalomo district means that more and more people are accessing HIV counselling and testing services.

“We decided to get tested so that I could learn my HIV status,” said 84-year-old Ezekiya Chilindila Musaka, after undertaking voluntary HIV counselling and testing at Siampayuma school organised by Kalomo Mumuni Centre. “I’ll encourage my children and grandchildren to get tested as well.”

What the Kalomo Mumuni Centre does
Kalomo Mumuni Centre was founded in 1997 by community members. The centre implements many programmes, including a voluntary HIV counselling and testing outreach programme designed to benefit communities in remote and rural areas of Kalomo district. Care and prevention teams provide counselling and testing services, while a dedicated team of caregivers, counsellors, laboratory technicians, and a trained drama group conduct outreach. The majority of these outreach workers are unpaid volunteers, with a mobile team of women and men leaving Kalomo by truck at 5:00 am and returning at 8:00 pm. To undertake this work, made possible in part by funding and technical support received from the Alliance Zambia country office, Mumuni Centre trains psychosocial counsellors, peer educators and caregivers. Through outreach activities, Mumuni Centre has broadened access to HIV counselling and testing services for underserved populations. These services provide life-saving information and encourage important behavioural change.

Kalomo Mumuni Centre’s programme coverage has spread quickly, beginning with two communities in 2002 and now operating in 25 zones. Within the first six months of 2006, 2,386 people received voluntary counselling and testing, with the majority aged 20-35 years. Out of a population of 167,000, an estimated 18.5% of people aged 15-49 are living with HIV, higher than the provincial HIV prevalence of 15.6, but lower than neighbouring Livingstone’s 31% HIV prevalence, the highest regional rate in Zambia.

Mumuni Centre provides ongoing home-based counselling and care services to those who test HIV-positive by trained voluntary caregivers and counsellors, and refers people in need of antiretroviral therapy to Kalomo District Hospital.

Counselling and testing sessions take place in the afternoon. Nurses from the District Health Management Team and local non-governmental organisations participate in the sessions. For each session, a trained counsellor is appointed to work as team leader. The role of a team leader is to liaise with all counsellors and coordinate the process. Counselling and testing sessions are usually held in local schools or underneath trees outside. The number of people waiting for counselling and testing increases as more and more people trek in from the fields. The queues grow as long as those seen during election times. The process stops only at nightfall.

While counselling and testing is underway, local caregivers continue to give health talks to community members on HIV and related issues. Drama groups keep children entertained and away from counselling and testing sessions.

Why Kalomo Mumuni Centre is unique
What makes this programme truly remarkable is the unique and different way Mumuni Centre interacts with community groups, local customary chiefs and headpersons, other non-governmental organisations and government departments to mobilise people to respond to HIV on a partnership basis.

Mumuni Centre collaborates closely with the government, from which it receives skilled counsellors, test kits and promotional materials. At district level, close liaison exists with the District Health Management Team and the District AIDS Taskforce. The Taskforce’s ability to respond to the pandemic is constrained due to lack of funds and innovation.

Mumuni Centre also works closely with community members. The Centre draws heavily on local resources, including donations of food and space for all community events. Like counselling and testing sessions, workshops are usually held in local school classrooms or underneath trees. Local customary chiefs and village headpersons are actively involved in the programme and support Mumuni Centre’s efforts.

Collaboration also exists with other non-governmental and community-based organisations in the district, which provide support staff and skilled counsellors. The advantages of diverse organisations working together include the pooling of skills and resources, capitalising on individual strengths, and producing a more effective programme than any single entity could develop.

Evaristo Kawaza, a Mumuni Centre field worker, has said, “Gaining the support of community leaders can mean the difference between successful or failed community mobilizations. It is dependent on the way the local teams approach the leaders and seek their support,” he added. “It is essential to involve them in the idea and consequently win their support. The headperson’s support for the programme has made it easier for the mobile teams to call meetings and for communities to donate in-kind.”

Community sensitisation meetings
A week before conducting outreach HIV counselling and testing, Mumuni caregivers visit different zones to hold community sensitisation meetings. This initial community mobilisation strives to raise public awareness about HIV, garner public support for the HIV prevention programme, and increase social acceptance of desired changes (such as condom use and utilisation of HIV counselling and testing services).

Community mobilisation efforts also anticipate and diffuse opposition, facilitate the development of partnerships, and support recruitment of community members to care and support teams. Subsequently, these partners and team members can assist with ongoing mobilisation efforts throughout the life of the project. These sensitisation meetings usually attract hundreds of people from all walks of life.

Mumuni Centre uses people who are open about their HIV status to raise awareness and promote counselling. Therefore HIV-positive caregivers, peer educators and counsellors are included in community meetings. During the meetings, announcements are made about when and where counselling and testing services will be provided. A question and contribution session allows people the opportunity to clarify issues. Some commonly asked questions include the role of condoms and counselling and testing in prevention. People also ask about antiretrovirals and how to obtain them. Other common worries include the growing number of orphans and vulnerable children and how best to support them, polygamy, “sexual cleansings”, and excessive beer drinking, as they relate to HIV and AIDS. These meetings explore the effects of the infection and innovative ways of improving the situation.

Results
Thanks to positive results from ten years of work, Mumuni Centre has gained a good reputation in Kalomo and in Southern Province region in general. Records show high attendance for each counselling and testing session. In addition to expansion in mobile outreach coverage from two operational sites in 2002 to twenty-five in 2006, the number of clients has increased dramatically. People in the region are much less shy or afraid to speak openly and strongly about condoms and sexual behaviour. Both women and men analyse cultural and religious sensitivities about condoms and sexual behaviour. In addition, the introduction of outreach HIV counselling and testing has helped save time and transport costs for community members.

As Moses Chali, a Mumuni Centre psychosocial counsellor observed, “Outreach voluntary counselling and testing services have enabled poor people in the remotest parts of the district to cut down on time and transport. They can now concentrate on food production,” he says. “More people are accessing counselling and testing since testing is now available in the community.”

Lessons learnt
Kalomo Mumuni Centre has learned a number of important lessons over the course of its work. Some of these lessons are listed below.

  • Successful community mobilisation is dependent on concrete participation and support from the community. In communities where Mumuni Centre is working, people have not just welcomed the programme but also contribute by donating space and food for community events. In addition, local customary chiefs, village headpersons, religious and political leaders are all actively involved in the programme and back Kalomo Mumuni’s efforts.
  • Community outreach efforts for HIV prevention can be greatly strengthened by working in partnership with small informal community groups, government departments and other organisations that share mutual objectives. Each partner brings its own expertise and resources. Such partnerships allow each institution to realise its goal while benefiting from the contributions of others.
  • Community sensitisation, outreach, and HIV counselling and testing activities can lead to greater awareness and less stigma and discrimination in the community.
  • There is a need to encourage the participation of boys and men in prevention activities, as they do not access services at the same rates as girls and women.

Kalomo
Situated 366 kilometres south of Lusaka and 120 kilometres north of Livingstone, Kalomo is a small rural district in Southern Province of approximately 15,000 square kilometres. The population is generally poor, and engaged in subsistence farming. Farming has been in decline due to livestock diseases, unfavourable national agricultural policies and recurrent drought, leading to decreased income and pressures on people’s access to basic needs. Many migrants are drawn to the region by precious stone mining. In addition to poverty, poor access to basic health care, and limited information exacerbate vulnerability to HIV. Accessibility in Kalomo is very difficult due to the limited and poor road network and lack of transport facilities. The roads in Kalomo are barely passable during the rainy season.

Both HIV testing services and public health services in general are inadequate in the district. HIV support activities are mainly carried out by non-governmental and community-based organisations. At present, other than Mumuni Centre, only Kalomo District Hospital provides HIV counselling and testing services, forcing people from the hinterland to either forgo counselling and testing or walk long distances. People who need antiretroviral treatment also have to travel long distances to the hospital.