Linking People to Services
In Southern Malawi, lack of awareness of HIV testing, prevention, and treatment resources is a major barrier to accessing HIV services. In an effort to address this — and bridge the gap between awareness of the importance of HIV-related health-seeking behaviors and adoption of those behaviors — BRIDGE II worked within communities to connect families and individuals to the HIV services they needed. BRIDGE II used two approaches to achieve this: the Community Referral Agent Model and the Promotional Model of Referral.
The International HIV/AIDS Alliance (IHAA), a BRIDGE II implementation partner, took the lead in this effort. Their goal was to strengthen referrals and links between community members, formal service providers (health centers, hospitals), and informal service providers (community-based organizations, home-based care groups, support groups) to increase the uptake of HIV and AIDS-related health services. They also worked to encourage appropriate HIV prevention, testing, and treatment-seeking behaviors and promote provider follow-up with clients after they received these services.
Trained community volunteers, known as Community Referral Agents (CRAs), referred individuals to a range of HIV services including: HIV testing; prevention- of-mother-to-child-transmission of HIV (PMTCT); family planning; antenatal care; voluntary medical male circumcision; treatment of sexually transmitted infections; and access to condoms. The CRAs also provided basic information on HIV prevention and treatment, and counseled individuals, families and the wider community on the importance of promptly seeking HIV-related healthcare. Some of the CRAs were HIV positive, which helped reduce stigma and normalize the engagement of people who are HIV positive in their communities.
The CRA model was implemented in four of the 11 BRIDGE II implementation districts. It was piloted in Chiradzulu and the lessons learned were used to scale up the intervention to three more districts: Thyolo, Mulanje and Phalombe.
The CRA model, while effective, was also found to be costly, which led to the creation of the Promotional Model of Referral. Implementation of the CRA model required a five-day training, refresher trainings and supplementary resources (referral books in triplicate, t-shirts, identity cards, bicycles), which cumulatively amounted to a large financial investment. Taking into consideration the communities’ need for the referral agents’ services and the high cost of implementing the CRA approach in all 11 implementation districts, BRIDGE II modified the model to the simpler Promotional Model.
In the Promotional Model of Referral, referral services were provided by village discussion group facilitators, previously trained by the project to engage communities in small group discussions on HIV prevention using its Transformative Tools. In line with the BRIDGE II Tasankha campaign, the small group discussions highlighted, among other things, the importance of seeking health services early and the kind of services available within each area and district. After group discussions on a particular topic, community facilitators referred people who expressed interest to go for services by giving them a referral form. The community facilitators later expanded their reach and referred people from within their villages whom they knew to have health problems.
From 2010 to 2014, the BRIDGE II referral program registered overwhelming success in referring and enabling over 200,000 people to access HIV testing and other health services.