Dignitas
Grant Update to The Funding Network - Fall 2006
Dignitas International: HIV/AIDS Community-Based Care in Zomba District, Malawi
Dignitas International is making great strides in Zomba District, Malawi, with the implementation and refinement of its model of community-based care. Community based care is a sustainable and cost-effective healthcare delivery approach, and an important strategy in delivering antiretroviral (ARV) therapy, reducing the risks associated with ARV treatment, and improving equity in access to HIV-related services. Enhanced ARV adherence resulting from community-based care can prevent the emergence of widespread drug resistance, thereby reducing the risk of a subsequent wave of HIV-related public health costs and consequent human suffering, poverty, famine and threats to peace, security and economic stability. The involvement of community groups in HIV services also reduces stigma, improves quality of life, and leads to an increased willingness to be tested and to discuss HIV/AIDS more openly. By bringing life-saving prevention and treatment to the community level, Dignitas International is helping to overcome the human resource crisis impeding Malawians from accessing the care they need.
In partnership with the Malawi Ministry of Health, Dignitas International is maximizing access to services with a view to nurturing and strengthening people living with AIDS, those affected by HIV/AIDS and their support structures. In 2006, medical services were decentralized from the Tisungane HIV/AIDS Clinic at Zomba Central Hospital to health centres in Chipini, Domasi and Mayaka (please see map below). By establishing community-based care programming at these sites, selected in collaboration with the Ministry of Health, Dignitas International is providing access to those living in villages or remote areas of the district. More people living with HIV/AIDS across the entire region are now beginning to receive vital treatment and care.
The Chipini Health Centre was chosen as the first decentralization site early in 2006, and ARV delivery began on January 27. Before ARVs were available here, patients had to cross Malawi’s second-tallest mountain to access treatment in Zomba town. The decentralization of essential HIV/AIDS medical care was greatly facilitated by the $17,202 grant from The Funding Network. This grant allowed Dignitas International to hire one full-time Clinical Officer to oversee the ARV decentralization process and provide much-needed support to centres that are severely understaffed and under-resourced. Gabriel Mateyu started the newly created position of Health Centre Coordinator on March 6. He quickly took responsibility for managing issues of ARV delivery at the Chipini Health Centre.
In addition to his supervision of weekly ARV delivery at the Chipini Health Centre, Mr. Mateyu began making regular site visits to Domasi on Thursdays and to Mayaka on Tuesdays in order to provide on-site support. He was also able to lay the foundation for the health centre staff training program, for which he developed the curriculum and materials. There are only a handful of healthcare workers at these centres, so training, support and supervision are fundamental to the staff developing skills in the management of opportunistic infections and ARV therapy. Their newly acquired knowledge serves two key purposes: first, it enables staff to monitor drug resistance and side-effects, and to support patient adherence to treatment; secondly, it creates an effective referral system for the most severe cases, who are sent to Zomba Central Hospital for critical care. Patient assessment at health centres prevents infection and disease while decreasing the burden on staff at the central hospital. Most importantly, this system increases access to treatment and medications for people unable to travel the long distances (primarily on foot) to Zomba town.
The impact that ARV decentralization has had in Chipini is inspiring, but much work needs to be done over the next six months to further decentralize ARV therapy to additional health centres. Without access to ARV therapy in Mayaka, for example, the sick and the dying have little hope because of the great distance to Zomba Central Hospital. Mr. Mateyu will continue to be an important asset in his role as the Health Centre Coordinator as Dignitas International prepares to further expand its reach in the district.
Increasing access is one important component of engaging people in a continuum of care, but ignorance and stigma still pose significant challenges. In this respect, Mr. Mateyu has been effective in the sensitization of influential community members to HIV/AIDS issues. He has scheduled regular meetings with traditional initiators and healers from villages in Zomba District. These meetings allow participants to develop strategies to decrease the spread of HIV through unsafe practices, and to try and establish a referral system for traditional healers. Therefore, the meetings are working to reduce stigma and engage respected community leaders in prevention activities.
Mr. Mateyu was also able to build working relationships with Ministry of Health staff. He coordinated a Zomba District working group on ARV decentralization (including representatives from the District Health Office, Zomba Central Hospital, District AIDS Commission, and Dignitas International) with the District Health Office.
In January of 2006, just under 700 people living with HIV/AIDS had been started on ARV treatment, and an average of less than 50 people were being started on these essential, life-extending medications every month. By the end of October, over 1,300 people were on ARV therapy, and over 100 people were being added each month – with over 150 people on ARV therapy at the Chipini Health Centre alone. In addition, clinical officers, nurses, and hundreds of community health workers and home-based care volunteers have been trained, and Prevention of Mother-to-Child Transmission programs have been established at seven sites.
In addition to the hiring of Mr. Mateyu in March, three Community Home-Based Care Nurses were added to the staff in the spring. David Kambalame began on April 3, Cecilia Chikondi Kamwana started on July 3, and Hilda Matalala joined on September 4. These nurses were hired to complete the community-based care team; like Gabriel, they have advanced decentralization, and they have helped to train, support and supervise members of the community-based care network in the more technical medical aspects of home-based care.
Community-based care is reinforcing consistent prevention messages at the community level. In addition, through home visits and patient referrals, AIDS-related disease is being reduced, enabling people to return to work to support their families and communities, to return to their fields to plant their crops and reduce hunger, and to continue raising their children.
The decentralization of effective treatment and prevention for HIV/AIDS will continue to have the greatest impact on the most vulnerable populations – women and children – and will maximize access to medial care for all people affected by HIV/AIDS throughout Zomba District. The decentralization process will also enable Dignitas International to refine its community-based care model for expansion within Malawi, and, ultimately, to other areas of the world.
As requested, please find attached Dignitas International’s most recently audited financial statements.
