The Promotional Model
The Promotional Model for Linking People To HIV Services
The Promotional Model of Referral was a modified and simpler version of the CRA model. In this model, referral services were provided by community facilitators, which the project had already trained 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 that are available within their 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.
Promotional Model Referral forms were simple and in duplicate. The forms outlined client biographic data just like those of the CRA Model. A duplicate of the referral form remained in the referral booklet while the other was given to the client to present to the service provider. The service provider signed the form after attending to the client as proof of providing the service. The client took back the referral form to the referral agent who used it for reporting. The referral agent referred to the duplicate that remained in the referral booklet to follow up with clients who did not bring back the referral form after some days or weeks depending on the date when the client indicated that he or she would go for the services. During this follow up visit, the agent would find out from the client if they managed to visit the service point and received the service or if they had not and reasons why. The referral agent provided additional support and encouragement to the client if the client did not go for the services.
The community facilitators participating in the Promotional Model received a one-day training before starting to refer people. Taking advantage of their existing knowledge and expertise on interpersonal communication skills and basic facts about HIV and AIDs, the Promotional Model training focused on how the referral agents could identify and approach people requiring referral services, how to take care of psycho-social and physiological health needs of their clients, and discussed the type of services available in their communities where they could refer people. After the training, the referral agents received a referral booklet to support their work. They were also encouraged to sensitize their communities, through other BRIDGE II structures, on their new role. The referral agents also introduced themselves to the Health Center staff, who had previously been introduced to BRIDGE II’s Promotional Model and with whom BRIDGE II had established a working relationship, to plan how they would work together over the course of time. This interface built confidence in the referral agents and enabled them later to approach Health Center staff with problems they encountered with ease. The project held quarterly review meetings with the referral agents as one way of promoting the sharing of best practices and to address challenges referral agents encountered. Under BRIDGE II, the Promotional Model was introduced during the summer of 2013 in the 7 districts where the CRA model was not being implemented.
The Promotional Model proved to be more cost effective than the CRA model. This was due to the fact that unpaid volunteers referred people from within their villages, and therefore did not need bicycles for transport or identity cards for identification during travel. However, establishment of the Promotional Model took quite some time due to low literacy levels of the volunteers, which made it hard for them to fill in the referral forms, and protests from health center staff, who thought they were being asked to take on extra work. Through quarterly supervisory meetings with both volunteers and health center staff, these issues were addressed.