Empowering Local Partners to Address HIV and AIDS

Fear of HIV and AIDS is widespread in West Africa, even in health care facilities. Having received little training in treating or providing care for people living with HIV/AIDS, health care workers are often unwittingly subjected to infection risks and/or unknowingly contribute to stigma and discrimination of people living with HIV and AIDS But there is hope: With assistance from Action for West Africa Region–Reproductive Health (AWARE-RH), local health care partners such as the Cameroon Baptist Convention Health Board (CBCHB) are strengthening their clinical and management skills and helping to decrease HIV transmission rates and improve the quality of services.

Preventing Mother-to-Child Transmission

Testing pregnant women for HIV is criticalbecause the risk of mother-to-child transmission of the virus can be significantly reduced by several doses of a low-cost drug called Nevirapine immediately before, during, and after delivery. In 2000, with funds from the Elizabeth Glaser Pediatric AIDS Foundation, CBCHB initiated efforts to screen mothers for HIV and to ensure adequate supply and use of Nevirapine in its facilities in the Northwestern and Littoral provinces of Cameroon.

In 2004, AWARE-RH and its sister project, AWARE-HIV/AIDS, identified CBCHB’s antenatal program, which includes the program for prevention of mother-to-child transmission, as one of the most promising health practices in Africa. Since then, AWARE-RH (implemented by EngenderHealth and partners) has continued to lend considerable resources and expertise to help strength the quality of CBCHB’s services and to replicate its antenatal services program across Cameroon and West Africa. Some achievements thus far include:

Of 178,415 women treated by CBCHB since 2000, 93% were tested for HIV after receiving counseling.
Rates of HIV infection in women in CBCHB service sites decreased from 10.5% in 2000 to 8.9% in 2004 and to 8.5% in 2006.
CBCHB’s HIV prevention activities have expanded from two to 300 sites across Cameroon.

Improving Quality of Care

To prevent HIV infection at health care facilities, AWARE-RH is engaging CBCHB’s staff to follow strict procedures for every activity, from taking blood to performing surgery. Thanks to AWARE-RH’s technical assistance, CBCHB is now effectively protecting staff and patients from risk of infection, easing tension and reducing stigma in clinics.

Once infection prevention measures are in place, AWARE-RH helps staff to focus on improving service delivery. Using an EngenderHealth tool called COPE (Client-Oriented, Provider-Efficient), staff are able to continually assess and improve quality of care, including assuring clients’ rights to privacy, quality care, and counseling.

“Thanks to COPE, we now know that we can assess ourselves and seek ways of improving without waiting on the hierarchy.”

—Eveline Mboh Asongwe-Nyindem, Regional Training Center, CBC Health Services Complex, Mutengene

Strengthening Leadership

Recognizing the essential role of leadership in quality improvement, AWARE-RH employs an EngenderHealth strategy called facilitative supervision, which emphasizes mentoring, joint problem solving, and two-way communication between supervisors and supervisees from all departments, including health services, administration, finance, and maintenance. Facilitative supervision results in effective communication among staff, efficient use of resources, and excellent service to patients. The medical monitoring skills of those who supervise service providers are also upgraded, to ensure that clinical service standards, norms, and policies are properly implemented.

Enhancing Family Planning Skills

As many medical professionals in West Africa are not able to stay abreast of new medical developments, AWARE-RH continually provides trainings in contraceptive technologies, such as the intrauterine device (IUD), and on topics such as counseling for family planning. In addition, EngenderHealth’s Men As Partners® (MAP) Program engages men to become equal partners with their wives in making family planning decisions, a critical challenge in the male-dominated cultures of West Africa.

“Facilitative supervision brings a lot of motivation and joy in work both to the supervisor and the supervisee. Members of our staff now request supervisory visits and are very happy to share their successes and challenges with their supervisors.”

—Evelyn Mboh, Director of Programs, Cameroon

A Model of Excellence for the Region

With its successful initiatives for prevention of mother-to-child transmission and quality improvement, CBCHB has emerged as a model for antenatal service provision in Cameroon and West Africa as a whole. To bolster CBCHB’s influence, AWARE-RH supports its regional training center in Mutengene in southwestern Cameroon and six practicum sites interspersed throughout the country. AWARE-RH has supplied the center and sites with family planning materials, such as IUDs, and antenatal care equipment, such as ultrasound machines, as well as other necessary items, including computers, air conditioners, and a bus. Even before the training center’s official opening in 2006, health care professionals from throughout Cameroon and West Africa began to visit, hoping to learn how to run a top-notch health care clinic that provides quality services, and how to prevent mother-to-child transmission of HIV.

To date, AWARE-RH has led trainings for the following CBCHB personnel at the training site:

14 nurses, in infection prevention
16 staff, to conduct COPE activities
34 supervisors, in facilitative supervision
40 nurses, in family planning skills
16 trainers, in engaging Men as Partners in reproductive health decision-making

The training center has also hosted technical trainings in prevention of HIV transmission for health professionals from Cameroon, Chad, the Gambia, Guinea, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, and Togo. Other donors, including the United Nations Children’s Fund (UNICEF) and the Glaser Foundation, are also contributing funds to the training center and using the sites for their own trainings.

Next Steps

AWARE-RH is currently strengthening the skills of specific CBCHB staff to become trainers in infection prevention, COPE, facilitative supervision, and family planning. With these trainers, AWARE-RH will continue to build the capacity of local organizations to improve reproductive health services and to provide newborns the chance to live free of HIV and AIDS.

For more information

For more information about AWARE-RH’s capacity building activities, contact Jeanne Rideout at jrideout@aware-rh.org. For more information about AWARE-RH’s work with the CBCHB, contact Simon Nchifor at snchifor@aware-rh.org.

AWARE-RH (Action for West Africa Region - Reproductive Health) is a five-year health improvement project sponsored by the U.S. Agency for International Development and managed by EngenderHealth that is designed to improve access to health care and quality of services in 21 West African countries. Guided by a vision of strong, relevant, and sustainable regional health institutions and networks, AWARE-RH proactively assists national and cross-border health programs in developing quality services that meet the needs of their people. To learn more about AWARE-RH, please visit www.aware-rh.org.