Centre for Socio-Medical Assistance (Côte d’Ivoire)

Starting Year: 1991
Main Topic Area: Community mobilization
Other Topic Areas: Palliative care · Religion · Resource mobilization

Contact Person: Dr Marc Aguirre
Phone: +225 41 80 83
Fax: +225 41 80 83
Email: 105223.3613@compuserve.com
Web Site: www.hopeww.org/

Address:
Hope Worldwide
B.P. 1021 Cidex 1
Abidjan 06
Cd'Ivoire

Implementers

HOPE Worldwide is an international, faith-based NGO. It works in collaboration with the Ministry of Health, the National AIDS Programme, and the University Hospital (Centre Hospitalier Universitaire - CHU).

Funding

Financial support comes from a variety of sources including HOPE Worldwide, USA; agencies and institutions that fund specific ongoing projects (prison, youth, counselling); income-generating activities (card-making); person with HIV/AIDS participation ($2.50 per month); donations.

Material support is also obtained through local donations by individuals and business, food and clothes drives.

Finally, technical support and training through workshops and conference attendance assistance has come from international agencies such as USAID, UNICEF, UNAIDS, UNDP, and Cooption Franse.

Objectives

The Centre for Socio-Medical Assistance began its work with the initial goals of:

- promoting decentralized care for persons living with HIV/AIDS
- providing accessible, affordable, and compassionate care
- supporting and encouraging patients to live positively with HIV.

Over time, its goals have expanded to include:

- developing a comprehensive continuum of care for persons living with HIV/AIDS through referrals and "care linking" with other services or institutions

- integrating persons living with HIV/AIDS into care and prevention programmes

- mobilizing community resources to develop and promote sustainable local action.

Background

The Centre for Socio-Medical Assistance (Centre d'assistance socio-mcale - CASM), an outpatient clinic for persons living with HIV/AIDS, opened its doors in February 1991. The motivation for this initiative came from volunteers (mainly from the Church of Christ) who were taking care of the sick and dying at the Infectious Diseases Unit of the CHU de Treichville. It soon became apparent that the vast majority of patients being admitted to the unit were HIV-positive, and that many were being abandoned, stigmatized, or neglected by family, friends, and medical personnel. After discharge, few had the means to pay for ongoing treatment, and there was an enormous need to provide persons living with HIV/AIDS with compassionate psychosocial support.

Persons living with HIV/AIDS often find that their family and community connections are shattered by the illness and the fear and stigma that accompany it. The guiding principle of CASM has been to restore a sense of solidarity between PLWHA and their community. It emphasizes that the most constructive answer to improving the quality of life lies in home and community care, and the participation of infected and affected family and community members. Encouraging the direct involvement of persons living with HIV/AIDS in counselling, prevention, support, fund-raising, income generation, and care are all activities that directly help the immediate situation.

Main Activities

CASM's main activities are as follows.

1. Medical care

CASM employs two full-time and two part-time doctors, a pharmacy assistant, and four project and support staff. It also has a four-bed capacity for those requiring IV treatments and monitoring. A nurse, who is openly HIV-positive herself, also volunteers regularly at the centre. The centre follows, as far as possible, treatment procedures outlined by the World Health Organization (WHO) in its AIDS Home Care Handbook as well as those adapted by local government. Most persons living with HIV/AIDS attending the centre are indigent and have little family financial support. Patients pay the equivalent of $2.50 per month for medical consultations and basic drugs, regardless of the number of consultations. These drugs include many of those found on the WHO essential drug list and are, for the most part, procured from the main government pharmacy at near cost price.

2. Referrals

The clinic acts as a referral centre for persons living with HIV/AIDS. Referrals come from:

- the nearby (main) infectious diseases hospital (CHU de Treichville) (the hospital, through an official agreement, offers the centre tariff reductions on all specialist consultations, labs, and hospitalizations)

- a voluntary testing and counselling centre (CIPS)

- a hospice centre (OASIS) that offers free care and hospitalization to those patients in the terminal phase of their illness and/or those who require prolonged convalescent care

- AIDS NGOs, associations of persons living with HIV/AIDS, and volunteers that provide support and follow-up at a community level.

It also takes a small proportion of referrals from the private sector and from health services in outlying regions.

3. Counselling

The centre employs two counsellors (one full-time and one part-time) and one psychologist. Various counselling and support strategies/techniques (such as group counselling, video viewing, and picture codes) are used to promote acceptance of seropositive status as well as positive living and coping strategies. Counsellors from the centre also form part of a "trainer of trainers" group, which is regularly called upon by the National AIDS Programme, institutions, and agencies. (CASM has also conducted multicentre research on the impact of counselling on persons living with HIV/AIDS.)

4. Home-based support

The centre has a team of approximately 20 community agents who provide home-based support for persons living with HIV/AIDS from the centre. During the home visits, agents assess living conditions, address psychosocial needs, and, when necessary, accompany ill persons with HIV/AIDS to the centre or to the nearest hospital. Community agents also spend one day a month at the centre counselling those attending the clinic. All information obtained and needs and services rendered are recorded after the visit to assure proper follow-up. Community coordinators interact regularly, and community agents meet once a month to discuss relevant cases, issues, problems, and ways to improve the programme.

5. Support for persons living with HIV/AIDS

In 1994, CASM facilitated the development of the area's first support group for persons living with HIV/AIDS, the Club des amis. Its goal was to provide opportunities for persons living with HIV/AIDS to share common experiences, hopes, and fears and to rebuild dignity, a sense of self-worth, hope, and friendships. Daily, a core of club members supports clinic staff with counselling and support issues, fulfilling their desired role as peer educators and counsellors. Club members are also actively involved in joint AIDS prevention programmes (including participating in the centre's theatre group, whose name, Kazenze, means "staying together"). The centre has also provided persons living with HIV/AIDS with nutritional, material, and financial assistance. With the support from the Lions Club, a local NGO called Initiative Plus, and a group of four to six volunteers, the centre provides a daily free breakfast to all its clients. The breakfast table also serves as a safe place for discussion and interaction between persons living with HIV/AIDS.

6. Income generation

Through various income-generating projects and donations, CASM has been able to provide small cash incentives to persons living with HIV/AIDS who have requested financing of viable projects or who need urgent financial assistance. These have been given mainly to support indigent HIV-positive women and children. Patients are encouraged to participate in card-making, earning 20 per cent of the sale price of each card.

7. Support for orphans

Together with one of the associations of persons living with HIV/AIDS, the centre has been able to support a small number of orphaned children by keeping them in school and providing them with basic support and provisions. The centre also holds an annual Christmas party for orphans and severely affected children. This event has been well supported by a wide range of partners.

8. AIDS prevention activities

The centre's prevention programmes have in recent years targeted four particularly vulnerable groups: women, young people, prisoners, underserved communities. Peer educators have been trained within most of these target groups. Group discussions, community conferences, slide shows, theatre, personal testimonies, and other strategies have been used to achieve the greatest possible impact. Many of these interventions have been designed in collaboration with other NGOs and youth and sports associations, and have included the participation of persons living with HIV/AIDS in their design and execution.

9. Volunteer contributions

In most of its activities, the centre benefits enormously from a large pool of volunteers. Many of the CASM staff first began working as volunteers. Volunteers come from AIDS NGOs and associations, religious groups, international institutions and agencies, and from concerned members of the community. Volunteers support the centre in a number of ways and at different levels. Within the centre, they provide counselling and support, help with the daily functioning of the centre (cleaning, typing, filing, and so on), cook and serve breakfast, make greeting cards for sale by the centre, and decorate the centre in order to make it a pleasant and inviting place. Outside in the community, the volunteers carry out home and hospital visits to patients; help with AIDS prevention campaigns, marches, and conferences; sell cards made at the centre; and carry out fund-raising and publicity. The volunteers, particularly those assisting within the clinic level, receive small financial and material rewards as well as free medical services. Coordinators, who meet regularly with volunteers, organize volunteer activities at both the clinic and community level.

Outcomes

- On average, 25-30 new patients are referred to CASM every month. The ratio of men to women referred is now equal, a major change since the first few years when it was almost 4 to 1. The average age of those referred is 25.

- The community agents make about 40 home visits to patients every month.

- The Club des amis is now a fully fledged association in its own right (with over 300 members) and has itself facilitated the creation of three other associations for persons living with HIV/AIDS.

- Prevention programmes have reached over 200,000 people over the past five years.

Lessons Learned

CASM's experience with resource mobilization provides some important lessons. Over the years, the centre has developed important local resources that underpin its activities and allow it to meet many of its objectives. The most notable of these are:

- a large pool of committed volunteers

- strong collaboration with associations of persons living with HIV/AIDS

- formal links with other services and institutions that strengthen the care continuum available to patients.

Developing such resources is essential for any project with CASM's goals and target population.

Given the severity of the epidemic and the fragile economic condition of the area, the centre at the same time has learned the limitations of local resource mobilization. Despite the development of local resources, the project is highly dependent on external funding, and lacks the resources to hire trained managerial staff. It does not have sufficient funds to purchase all the basic drugs it needs to meet patient demand. Project staff believe that untapped local resources exist that might be used to reduce its dependence on outside donations, but the centre has been unable to find entry to these resources.

Further Reading

See www.hopeww.org/Where/Africa/africa5.htm for a general description of this project.