Overview of the Implementation of the Linked Overview of the Implementation of the Linked Response for Prevention, Care and Treatment of Response for Prevention, Care and Treatment of HIV/AIDS, Sexually Transmitted Disease, and HIV/AIDS, Sexually Transmitted Disease, and Reproductive Health Issues Reproductive Health Issues Presented by: Presented by: Dr. MEAN CHHI VUN Dr. MEAN CHHI VUN Director of NCHADS Director of NCHADS
Outline Outline • Why Linked Response is needed? • What is Linked Response? • Objectives of Linked Response • Service package of Linked Response • Implementation and Results of Linked Response: Phase 1 • Next step
WHY Linked Response is Needed? (1) WHY Linked Response is Needed? (1) Missed Opportunities to Provide information and Refer patients to relevant o relevant Missed Opportunities to Provide information and Refer patients t Health Services to appropriate Testing or Treatment Health Services to appropriate Testing or Treatment Poor Communication between Health care providers and Community Base ase Poor Communication between Health care providers and Community B Support Team Support Team All Health Service Deliveries are not available at the same Health Facility th Facility All Health Service Deliveries are not available at the same Heal Limited Access to Health Facility due to Geographical and Resource ce Limited Access to Health Facility due to Geographical and Resour Constraints Constraints
WHY Linked response is Needed? (2) WHY Linked response is Needed? (2) � � � FP/BS CBS Team VCCT TB Unit � � � ANC Service STI Clinic PAC OI and ART CBS Team Maternity Service NCMCHC NCHADS
WHAT is Linked Response ? WHAT is Linked Response ? NCHADS-NCMCH NPH VCCT FP/BS ANC STI Clinic CBS Team Refer TB Clinic Maternity COMMUNITY Follow Up OI and ART Service PAC CBS Team Inform / Refer / Follow up
Linked Response: Institutional Linkages at National Level Linked Response: Institutional Linkages at National Level � � � NCHADS NCMCH NPH HIV/AIDS RH,MNCH,BS PAC STI,OI/ART Nutrition, EPI VCCT Partners CENAT NAA NGOs TB CBOs NCWC FBOs Dep. Of Medical Service: RH, HC Laboratory,
What is Linked Response: Strengthening R&F Linkages between and What is Linked Response: Strengthening R&F Linkages between and within HFC services and Community- -Based Care Based Care within HFC services and Community R & F HFC CBS VCCT ANC BS Referral & Follow-up Safe delivery p u - STI w o OI & ART l l o F PAC & Linked EPI l a r TB r Response e f Nutrition e R Lab Data Management Referral & Follow-up CBS CBS RH R & F HC CBS Community level (HBC)
Linked Response: Objectives Linked Response: Objectives Contribute to the strengthening of Cambodia’ ’s Health Care System s Health Care System Contribute to the strengthening of Cambodia Strengthen the existing Reproductive Health Services Strengthen the existing Reproductive Health Services Increase Access to HIV Prevention, Testing and Care and Treatment including t including Increase Access to HIV Prevention, Testing and Care and Treatmen PMTCT Services. PMTCT Services. Change Clinical Management to Public Health Approach Change Clinical Management to Public Health Approach Strengthen Ownership including Leadership and Management of OD Management anagement Strengthen Ownership including Leadership and Management of OD M Team and HC Management Committee Team and HC Management Committee
Linked Response: Service Package Linked Response: Service Package � Hub Hub One stop service: VCCT, PMTCT, OI/ART, One stop service: VCCT, PMTCT, OI/ART, � STI, FP, logistics and data management, STI, FP, logistics and data management, referrals and links to HCs HCs, Hub, and Community , Hub, and Community referrals and links to � Satellite Satellite VCCT, ARV prophylaxis, safe delivery, VCCT, ARV prophylaxis, safe delivery, � OI prophylaxis for newborns, DBS collection, OI prophylaxis for newborns, DBS collection, infant feeding education, Referrals and links to infant feeding education, Referrals and links to HCs, Hub, and Community , Hub, and Community HCs � Linked Health Center Linked Health Center Blood draw for HIV testing, Blood draw for HIV testing, � referrals and links to HCs HCs, Hub, and community , Hub, and community referrals and links to
Linked Response Implementation: Demonstration Sites Linked Response Implementation: Demonstration Sites Prey Veng Veng Province: Province: Prey LR Demonstration Project: 4 ODs; 47 HC (supported by Clinton Fo LR Demonstration Project: 4 ODs; 47 HC (supported by Clinton Foundation) undation) 1. OD OD Neak Neak Loeung Loeung: RH and 17 HC (LR Hub): Pop.: 175,860 (Female 15 : RH and 17 HC (LR Hub): Pop.: 175,860 (Female 15- -49:23,639, PW: 4,748) 49:23,639, PW: 4,748) 1. 2. 2. OD Kg OD Kg Trabek Trabek: RH and 11 HC : Pop. : 129,146 (F15 : RH and 11 HC : Pop. : 129,146 (F15- -49:17,360, PW: 3,616) 49:17,360, PW: 3,616) 3. OD OD Preah Preah Sdach Sdach: RH and 9 HC: Pop. : 112,941 (F 15 : RH and 9 HC: Pop. : 112,941 (F 15- -49:29,365, PW: 2674) 49:29,365, PW: 2674) 3. 4. 4. OD OD Mesang Mesang: RH and 10 HC: Pop: 121,735 (F 15 : RH and 10 HC: Pop: 121,735 (F 15- -49: 31,651, PW: 3287 49: 31,651, PW: 3287 Takeo Province: Takeo Province: Toatal Toatal pop.: 854,727 pop.: 854,727 AD:10.; Commune:100: Village:1117 AD:10.; Commune:100: Village:1117 OD: 5; RH: 5; HC: 70 OD: 5; RH: 5; HC: 70 LR Demonstration Project: 1 OD ; 20 HC (supported by ITM, UNAIDS LR Demonstration Project: 1 OD ; 20 HC (supported by ITM, UNAIDS/WHO) /WHO) 1. OD OD Kirivong Kirivong: 1RH; 20 HC : 1RH; 20 HC 1. Total pop. : 223,091 (F 15 Total pop. : 223,091 (F 15- -49: 49,080, PW: 6,336) 49: 49,080, PW: 6,336) 6 satellites 6 satellites
When: LR Timeline (Prey Veng Veng) ) When: LR Timeline (Prey Cluster Ministry of Phase 1 Coordination Health Implementation Meeting Approval Cluster Coordination LR Training of Workshop Orientations HCW January February April October December March 2008 2008 2008 2007 2007 2008
When: LR Timeline (Prey Veng Veng) ) When: LR Timeline (Prey Decentralization Assessment of community Contracting of HBC of Key Activities support mechanisms PMTCT Phase 2 Regular Training for Implementation Refresher Coordination Technical Training Meetings Support Team April July August February October October ??? 2008 2008 2008 2008 2008 2008 2008 ongoing
Implementation of Linked Response Implementation of Linked Response Facility Support Component: Hub Facility Support Component: Hub � Recruitment of Logistics Manager Recruitment of Logistics Manager � � Recruitment of Data Manager Recruitment of Data Manager � � Refurbishment of Reproductive Health Facility Refurbishment of Reproductive Health Facility � � Support for Cluster Coordination Activities Support for Cluster Coordination Activities � � Establishment Establishment of LR Technical Support Group of LR Technical Support Group � � Monitoring and Oversight Monitoring and Oversight �
Implementation of Linked Response Implementation of Linked Response Facility Support Component: Satellite Facility Support Component: Satellite � Construction or Renovation of VCCT � Construction or Renovation of VCCT � Refurbishment of Reproductive Health Facility � Refurbishment of Reproductive Health Facility � Training of HCW: (Nurses, Midwives, Lab, DBS collection) � Training of HCW: (Nurses, Midwives, Lab, DBS collection) � Support Mentoring from � Support Mentoring from Hub Hub to to Satellites Satellites
Implementation of Linked Response Implementation of Linked Response Facility Support Component: Linked Health Center Facility Support Component: Linked Health Center � Training for counseling and blood draw for HIV � Training for counseling and blood draw for HIV testing testing � Refresher Training � Refresher Training � Support for blood sample transport activities � Support for blood sample transport activities � Monitoring and Oversight � Monitoring and Oversight
Implementation of Linked Response Implementation of Linked Response Community Support Support Component: HBC teams Component: HBC teams Community � Train designated PMTCT team member to focus on pregnant Train designated PMTCT team member to focus on pregnant � women women � Support pregnant women through testing, necessary treatment, Support pregnant women through testing, necessary treatment, � prophylaxis, safe birthing, newborn testing prophylaxis, safe birthing, newborn testing � Coordinate with midwives and Coordinate with midwives and TBAs TBAs to identify pregnant women and to identify pregnant women and � educate on linked response network educate on linked response network � Cover referral incentives and transportation costs as needed Cover referral incentives and transportation costs as needed �
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