Reproductive Health, Mother & Child Care

Reproductive Health,Mother & Child Care
OPERATIONAL RESEARCH AND HIV/AIDS
By James Achanyi-Fontem
Cameroon Link
Nearly four decades after the emergence of the HIV/AIDS pandemic, biomedical, and epidemiological research has identified and described in great detail the nature of HIV infection and its modes of transmission.
These findings have been used by scientific experts to develop effective drug treatments, targeted behaviour change strategies, and sensitive surveillance and modelling tools.
Yet far less research has been devoted to basic operational issues that affect the delivery of services in prevention, care, and support.
We have learned much about which behaviours place persons at risk and have some sense of what types of interventions work to prevent HIV transmission, but we know far less about why and how these interventions work, what they cost, and where and when they can be successfully replicated on a large scale.
These questions are especially important in Cameroon in general and the Littoral or the south west provinces in particular, which are our main target populations, where more than 90 percent of HIV infected people live, because prevention, care, and support interventions remain the primary tools for dealing with the pandemic.
To successfully design and implement effective HIV/AIDS prevention and mitigation activities, we suggest that the program managers and policy makers urgently need accurate and timely information on the operational mechanisms that make these programs work in an era of scarce resources.
It is also critically important that decision makers be guided by the best and most current research evidence to determine which elements of policy and service programs are the most cost-effective in reducing new HIV infections and mitigating the effects of AIDS.
BREAKING NEW GROUND
As we apply for the frame work agreement for collaboration with the ministry of public health and international institutions in Cameroon, we would be reinforcing our strategies in the next five years (2009/2014) with focus on operational mechanisms of implementing policies and programs.
In addition to previous objectives, the focus will include:
- Identifying cutting-edge issues affecting the design and delivery of STI/HIV/AIDS programs.
- Test new approaches to prevention, care, and support programs through practical, field-based research.
- Disseminate the findings from the research.
- Recommend best practices to improve policies and programs.
Since the inception in 1992, the Cameroon Link (Human Assistance Programme) has worked with a bread group of local, regional, and international organisations to identify the key constraints to service delivery and to test viable alternatives to programs with limited effectiveness.
Focusing on some broad topic areas, Cameroon Link HAP is one of the first STI/HIV/AIDS projects in Cameroon to use operational research to identify program problems and test new solutions to overcoming these problems.
The operational research process has been employed extensively by Cameroon Link in collaboration with the Ministry of Public Health, IBFAN Africa, WABA, FECABPA, German Technical Co-operation, GTZ, Care International and the Cameroon Association of Newspaper Journalists, CANJ, over the last ten years in reproductive health service delivery.
It has proven extremely effective in improving the quality and effectiveness of service delivery programs in large part because it has applied research that places a premium on involving key stakeholders in the entire process.
These stakeholders are many and include government ministries, local NGOs, Local community leaders, people living with STI/HIV/AIDS, research agencies, and international organisations, amongst others.
Multi-stepped Approach
Cameroon Link operations will in the next five years involve five basic steps:
- Problem identification and diagnosis.
- Strategy selection.
- Strategy experimentation and evaluation.
- Information dissemination.
- Results utilisation.
From past experiences, we have noted that this process increase the efficiency, efficacy, quality and cost-effectiveness of prevention and care services, and changes individual behaviour by making services more accessible and acceptable.
The Cameroon Link Human Assistance Project concentrates on working with local service delivery organisations and groups to design and implement three basic types of field-based studies.
EXPLORATORY STUDIES
These studies are needed whenever there is a perceived problem, but the nature and extent of the problem are not known. Such studies can identify individual behaviours, and the legal, cultural, and socio-economic factors that influence risk and vulnerability, as well as the parameters of a service delivery.
FIELD INTERVENTION STUDIES
This study is useful when the factors responsible for a problem situation is or are known (i.e., lack of finances, lack of training, inadequate involvement of local NGOs, lack of collaboration of target groups, high prevalence of risk behaviours).
The most efficient and cost-effective means of prevention have yet to be determined. Field intervention studies test new approaches to behaviour change and new modes of configuring and delivering prevention and care services.
EVALUATION STUDIES
Often the problem situation is known from earlier diagnostic studies and a range of possible solutions have been identified from earlier field intervention studies, but the effect and sustainability of implementing these solutions in the larger community, beyond the confines of a tightly controlled intervention study are not known.
Evaluative studies are a valuable approach for examining the out come or impart of interventions that are implemented through out a service delivery environment.
Regardless of the type of study, the goal is always to improve the way in which policies are designed and implemented. This goal can only be met if each activity is accompanied by a strong information dissemination and results utilisation program.
This explains the connection of the Cameroon Association of Newspaper Journalists, AJPEC, partnership in the Human Assistance Programme and the raison d’être of the revival of the Cameroon Link newspaper for the presentation of NGOs activities through the forum columns. Articles, feedback and suggestions or information will be welcome.
STI INTERVENTIONS
PUTTING NEW PREVENTION AND TREATMENT APPROACHES TO THE TEST AS PROJECT
One of the most important prevention discoveries made about HIV is that the presence of other sexually transmitted diseases (STDs) greatly increases vulnerability to and transmission of the virus.
This has been a key factor in HIV’s virulent spread in Cameroon, where untreated STDs are also endemic. Thus, strengthening STD prevention and management and, wherever possible, incorporating these efforts into HIV prevention programs have become a key global strategy for curbing the virus that causes AIDS.
But this is not a simple matter. The stigmatisation of those with STDs, a very common problem, inhibits people from seeking treatment.
Designing effective behaviour change campaigns that address sexual behaviour is often difficult, especially if literacy is low. Several constraints on national health budgets restrict the implementation of STD prevention and treatment programs, just as poverty limits the ability of individuals to pay for their own treatment.
Access to care is also limited, particularly in rural areas isolated by weak infrastructure. Even in urban towns with more resources, STD prevention and control programs are often insufficiently funded.
Despite the growing wealth of knowledge about STDs, few large-scale prevention and treatment programs have evolved in the districts where the need is greatest.
One of the biggest challenges is how to translate important research finding into effective, affordable and real programs that can be adapted to very different settings.
A key lesson learnt from past experiences is that like the HIV and STD epidemics themselves, real solutions are complex and multi-faceted.
STI PREVENTION STRATEGIES
PERIODIC PRESUMPTION TREATMENT
This is mass treatment of individuals presumed to be infected with one or more STDs, without attempting to make an individual diagnosis. This strategy can be targeted to persons with known high-risk behaviours like sex workers or free girls.
SYNDROMIC MANAGEMENT
Treating a patient for all likely causes of a symptom or sign of STD, rather than on the basis of a specific diagnosis.
PEER EDUCATION
Training individuals in health education and counselling techniques so that they can educate others in their peer groups.
POLICY OF 100% USE IN SEX ESTABLISHMENT OF CONDOMS
An intervention that seeks to reduce transmission of HIV and other STDs to and by sex workers by ensuring that condoms are used for every act of intercourse.
I.E.C PROJECT OBJECTIVES
LONG TERM
The training of staff and production of information material and publication will enhance a greater awareness of the local communities and contribute to the process of community development by mobilising the local communities towards involvement in the prevention of STD/HIV/AIDS/TB and social welfare. Media organisations must be regularly implicated in I.E.C programs.
CONCLUSION
To back up this executive summary, please click the profile of Cameron Link, its projects plan of action from 2009 to 2012 to get highlights of major health initiatives.