Community-centered Clinical Services: Case
Studies and Lessons Learned from
Implementing Key Population Programs in
India
Anjana Das
STI Capacity Building
Scale and Scope of Avahan Program
• 6 states, 83 districts, 600+ towns
• 129 NGOs
10 Years = USD $376 million
2004 – 2013
Phase 1 – Scale-up 2004-2009
Phase 2 – Transition 2009 - 2013
Program
coverage
• Combined State Population
• ~ 300 million
• High risk groups covered
• FSW – 221,000
• MSM & TG – 81,000
• IDU – 18,000
• Men at risk – ~5 million
• Outreach, BCC
• Commodities (condoms, lubricants,
needles)
Prevention
Package
• Clinical services for STIs + counseling
• Referral - TB, HIV testing, ART
• Community mobilization
• Structural Interventions: Local advocacy,
police sensitization, crisis response,
community advisory committees
STI service delivery structure
Community Led- Approaches for
Clinical Service Provision
Community participation guidelines for planning, implementing and
monitoring services in Avahan COGS & CMP
Phase 2
(2009-2013)
Transition
• Preparing CBOs to lead STI
program components
• Service committees increasingly led
by community non-peers
Refined with learnings
Phase 1
(2004-2009)
Scale-up
• Training and supporting peer
outreach workers
• Establishing service committees
e.g. STI, care and support
• Appointment of community
members in clinic staff positions
Documenting Community-centered Clinical Services:
Case Studies and Lessons Learned
Purpose
• Document innovative approaches used in
resource-constrained settings
• Share good practices and lessons learned
• Strengthen capacity of KP programs elsewhere
Intended
audience
• Primary: KP program implementers
• Health officials, donors, policy makers
• Replicability and scalability
Case study
selection
criteria
• Demonstrated improved outcomes
• Relatively simple processes
• Acceptable and accessible by KPs
List of Thematic Areas/Chapters
• Community-led Approaches for Clinical Service
Provision
• Customizing STI Service Delivery Models
• Sexually Transmitted Infections (STI) Care and
Treatment
• Continuum of Care
• Clinic Management Systems
• Sustainability and Transition
Lessons Learned
• Increased clinic utilization
Community
Participation
Service
Delivery
Models
• Has the potential to lead to a change from an
externally-led to a community-led program
• Tailored to KP typology and local resources
• Improved accessibility
• Static + outreach clinics cost-effective in large
urban areas
• Standardized guidelines and SOPs
STI Care and
Treatment
• Regular quality monitoring and use of data
improved services
• POC tests increased syphilis screening
Lessons Learned (2)
Continuum of
care
Clinic
Management
Systems
Sustainability
and Transition
• Demand generation and HTC at outreach clinics
led to four-fold increase in HIV testing
• Primary HIV care & support, TB screening
provided on-site with referral linkages for
higher-level care
• Capacity building mechanisms for clinic staff
ensured quality of services
• Stock management systems for drugs and other
commodities prevented stock-outs and wastage
• CBOs should be involved in transition planning,
post transition support necessary
• Early planning for sustainable mechanisms for
clinical services
Acknowledgements and
Key References
• Bill & Melinda Gates
Foundation
• Implementing agencies
• Our community members