Society for Community
Development
HAST REPORT
SOCIETY FOR COMMUNITY DEVELOPMENT
SCD
JUNE 2010
2
TABLE OF CONTENTS
Title page ............................................................................................................................................................ 1
Table of Contents ............................................................................................................................................. 2
introduction ................................................................................................................................................. 3
Overview of HAST ............................................................................................................................................... 4
Objectives of HAST ...................................................................................................................................... ……5
Hast monthly activities January-June................................................................................................................6
Evaluation.......................................................................................................................................................15
Challenges of HAST program...........................................................................................................................17
Benefits of HAST program...............................................................................................................................18
Successes of HAST program.............................................................................................................................18
Conclusion......................................................................................................................................................19
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INTRODUCTION
HIV/AIDS, Sexual & reproductive health and TB services (HAST) is a GHAIN concept of an
integrated program delivered through a decentralized approach at local government
area (LGA) level.
The HAST project was launched in Nigeria in 2008 with the goal of contributing to the
reduction of the burden of HIV, STIs and TB in selected LGA in some states in Nigeria by
enhancing the efficiency of program implementation and service delivery.
In 2010, FHI/GHAIN added Orphans and Vulnerable children (OVC) as a component in
the HAST project. A lot of OVC were enrolled and service delivery has since
commenced.
To do this effectively, five Community Based Organizations (CBOs) were engaged with
Catholic Action Committee on Aids (CACA) as the umbrella CBO to coordinate other
CBOs in the service delivery in communities in Abuja Municipal Area Council in the FCT.
Individual CBOs also have trained Community Volunteers and Peer Educators who are
resident in the communities.
This report is a summary of the HAST program from the month of January to June 2010.
It is document compiled by Society for Community Development (SCD).
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OVERVIEW OF HAST
HIV Epidemic remains a public health problem of enormous magnitude The government
of Nigeria, has set an ambitious targets for treatment delivery, but services remain
concentrated in a few “cluster zones” while people in rural areas struggle to get care.
Frequent visits to the often distant hospital and the strict adherence to antiretroviral
therapy on one hand, and finding ways of livelihood on the other pose major challenges
to people living with HIV. Despite the availability of effective prevention and treatment,
STI have equally remained a major public health problem in Nigeria
Sexually Transmitted Infections (STI) not only increases HIV transmission risk but also
carry the potential of other serious complications including fetal loss, stillbirths,
infertility, ectopic pregnancy and severe congenital infections. STIs are a major health
priority in Nigeria, both because of the high prevalence of these infections, and because
of the morbidity and mortality associated with them particularly since the advent of
HIV/AIDS.
Nigeria has an estimated incidence of 283 of all forms of TB per 100,000 population per
year and prevalence of 536 per 100,000 population; making it the highest TB burden
country in Africa
(WHO Global TB Report 2007)
The Directly Observed Treatment Short course (DOTS) Strategy was adopted in 1993
with subsequent expansion to all thirty-six states. The National TB case detection and
treatment success rates keeps falling short of the National targets of 70 percent and 85
%. Despite the 100% state coverage, accessibility to DOTS services still remains limited
as the large portion of the population live some distance from the DOTS centres. The
new global Stop TB strategy emphasizes, as an essential component of TB control, the
involvement of communities and patients affected by tuberculosis.
The HAST model is holistic client-centered care acknowledging the links between HIV,
STI, TB and sees it as a cluster of diseases and health concerns affecting a large number
of people, rather than separate conditions. It aims to structure the provision of
comprehensive health care services to clients who have these infections as well as to
those at risk.
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HAST is first and foremost about preventing HIV, TB and STI infections through
preventive education, health promotion, screening and early detection. The HAST
model is premised on the assumption that successfully integrated programs in the PHC
services are more efficient, especially in resource constrained environment such as the
Nigerian public health system.
It provides opportunities for meaningful involvement of patients and communities
especially within the PHC program structure
It is expected that efficiency is will be brought about by the pooling of resources,
increased knowledge and competencies of personnel, streamlined systems of
procurement, information management and community involvement and participation
The overall goal of the HAST proposal is to contribute to the reduction of the burden of
HIV, STIs and TB in selected LGA in several states in Nigeria by enhancing the efficiency
of program implementation and service delivery
OBJECTIVES
• Introduce an integrated HIV/AIDS, STI and TB (HAST) services model in health
facilities within the LGA
• Facilitate community/home-based HIV/AIDS, STI, and TB care and support.
• Increase community involvement, capacity and participation in HIV/AIDS, STI and
TB care and support.
• Standardise the M&E system and tools used in the LGA, so as to reflect the HAST
concept.
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HAST MONTHLY ACTIVITIES
JANUARY -JUNE
HIV/AIDS TUBERCULOISIS AND SEXUAL TRANSMITTED INFECTION
Human Immunodeficiency Virus (HIV) is a virus disabling immune system: either of two
strains of a retrovirus, HIV-1 or HIV-2, that destroys the immune system's helper T cells,
the loss of which causes AIDS.
HIV Epidemic remains a public health problem of enormous magnitude in Nigeria. AIDS is
just one more problem among many in Nigeria. The epidemic is a development crisis that
is ravaging the country and undermining all social and economic development efforts.
AIDS affects all sectors which include health, agriculture, children, labour force, Women,
family education and security. However, the plight of those who are either infected or
affected remains the most challenging task for development actors. With all the social
factors contributing towards stigma and discrimination of PLWHA, make it more difficult
for PLP to openly disclose their status, thereby thwarting the effort for people who are
infected to access the readily available services provided by Government for PLP.
It is in line with the challenges of HIV/AIDS that Family Health International/GHAIN
concerted the integrated HAST program bearing in mind that services this time will be
delivered through a decentralized approach at Area councils in the FCT and Local
Government Areas in other state where the program is present.
Society for community Development (SCD) through Health Care Providers, Community
Volunteers and Peer Educators delivered this program in Gwagwa and Jiwa wards under
the FCT Zone. Support was also given from Catholic Action Community of Aids and Family
Health International/GHAIN.
The line of communication is usually from FHI/GHAIN through the umbrella NGO (CACA) to
other CBOs and PHC and then eventually to Community volunteers and Peer Educators.
The community volunteers are fully equipped with trainings, capacity building and other
materials to help them carry out their duties effectively at the community level. This also
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applies to the Peer educators.
While some activities changes every month, some other activities are ongoing. Some of
the ongoing activities include; HIV/AIDS Counselling and Testing (HCT), TB referral, testing
& treatment and STI treatments.
The Peer Educator’s reporting format is as shown below
Peer
Educators
(insert First
name only)
AONLY
AB-ONLY
TOTAL NO SBC
DISTRIBUTED
BOOKLETS
NEW
REPEAT
NEW
REPEAT
M
M
M
M
F
F
F
MATERIAL
LEAFLETS
FLYERS
TOTAL NO OF REFERALS MADE
TO:
ART
STI
HCT
TB
OTHERS
F
SHAFATU
JUMMAI
GODWIN
COMFORT
ABUBAKAR
SALISU
KHADIJAT
MOHAMMED
TOTAL
SCD is currently working with seven (7) Community Volunteers and eight (8) Peer
Educators.
For Community Volunteers, referral forms are made available to them; volunteer activities
tally cards are also made available to them. There are varieties of this tally cards. Some
include; community treatment care and support tally card, tracer diseases 1 & 2 tally cards
and other community activities 1 & 2 tally cards.
Community Volunteers are also provided with a home based care kit each which contains
materials for first aid treatment and other necessities like paracetamol, iodine and detol.
8
In the month of January, the usual referrals were done by Community Volunteers. For TB,
suspects were referred to PHC for test and those that were confirmed positive were
placed on DOTS treatment. Community Volunteers were also admonished to refer the
family members of a TB patient for a test to de conducted for them all since TB is airborne.
Often times in the community, they do not realise they have STIs until they visit the PHC.
When confirmed positive to STI, they are placed they are treated.
SCD formed a support group and this group comprises of PLWHA in Gwagwa and Jiwa
ward. This support group meets monthly to share their views and encourage each other
on how to live positively. They also share their challenges and deliberate on the way
forward.
Speaking at the meeting in the month of January, Elizabeth Thomas said the major
problem faced by People Living With HIV/AIDS is unemployment and inability to get a
stable source of livelihood. She added that there are a lot of PLWA who will not readily
make their HIV status known because of the fear of stigmatization and discrimination. In
the same development, Justina David said when a PLWH declare their HIV status openly;
such people become the topic of discussion in the community.
In one voice, support group members pleaded with SCD to assist them make a difference
in their lives.
They were supported with nutritional materials and also encouraged to eat healthy.
From the M&E report in the month of January, referrals (HIV/AIDS, STI & TB) were done
which the PHC in Gwagwa and Jiwa wards handled respectively.
In February, support group members testified that there is a great transformation in their
lives as they have learnt a lot from each other and from SCD during the monthly support
group meeting. They requested SCD not to relent in her constant effort of calling for the
monthly support group meeting. While some of them said stigmatization is still a major
challenge for them, others said that eating rightly is sometimes hard because of lack of
funds. On the way forward, SCD pledged support for PLWHA farmers and encouraged all
PLWHA to adhere to their drugs.
From the monthly M & E, referrals were done by community volunteers and peer
9
Educators are also working tirelessly to reach their individual target groups.
OVC was introduced as one of the components of HAST. CBOs and community volunteers
where trained on OVC and Home Based Care. This was to prepare them for the task ahead.
March was an eventful month as enrolment of OVC commenced with full force this
month. All the CBOs were given different target for the enrolment. For SCD, the target was
300 OVC which was achieved. Prior to the enrolment, there was community mobilization
and sensitization on OVC resulting from HIV/AIDS, TB, other terminal; diseases that can
orphan a child and leave him/her helpless.
Speaking at the community mobilization, Sani told community members that there are
criteria that qualify a child as an OVC; he also encouraged them not to send only a child as
there is vital information that will require the presence of the caregiver.
More challenges came up in the support group meeting of the month of March as PLWHA
said they are being continually stigmatized and their means of livelihood is affected. They
also requested for aid in the area of food supplement. While encouraging PLWHA, Tony
told them to be courageous and not to be depressed as the public are being educated on
the ills of stigmatizing PLWHA. He also added that coming for meeting like this will boost
their moral and encourage them to be positive in their thoughts.
SCD distributed a few food supplements to all PLWHA that attended the meeting,
promising them that more support will come soon.
From the M & E report; 97 and 194 home visits were carried out in Jiwa and Gwagwa
wards respectively. Two TB patients receiving treatment in Gwagwa and Jiwa respectively.
TB patients receiving treatments were 2 for Gwagwa and Jiwa wards respectively
HIV prevention PE activities
Number of new A only 289
contacts made
Number if repeat A only 130
contacts
Number of new AB contacts 26
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made
Number of AB repeat contacts 57
Number of referrals
78
Number of SBC materials 2
distributed
Target group include; Teenagers, married youths and adults.
In the month of April, OVC enrolment was intensified and a target of registering 500 OVC
was given to SCD. During this enrolment however, it was noticed that a lot of OVC did not
have access to passport which was a requirement to be enrolled. SCD made it appoint of
duty to snap them and attach to their forms. SCD did not just mobilize OVC in Jiwa and
Gwagwa communities for the enrolment; they also visited some communities under these
wards. At the end of the month, the target given was long exceeded and several OVC are
still awaiting enrolment.
Below is the M & E report of the monthly Community Volunteer and Peer Educator
activities for the month of April.
HIV prevention PE activities
Number of new A only
contacts made
Number if repeat A only
contacts
Number of new AB contacts
made
Number of AB repeat contacts
Number of referrals
Number of SBC materials
distributed
367
303
25
49
106
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COMMUNITY VOLUNTEER ACTIVITIES:
JIWA WARD: Total number of Home visits carried out is 135, total number of ART
referrals carried out is zero, total number of Tuberculosis patients receiving treatment
support is zero, total number of clients receiving care and support is zero.
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GWAGWA WARD: Total number of Home visits carried out is one 178, total number of
ART referrals carried out is zero, total number of Tuberculosis patients receiving treatment
support is zero, total number of clients receiving care and support is zero
The agenda of the support group meeting for the month of April was not different from
that of other months as PLP discussed their challenges and shared their experiences. They
decided visit each other at least once a month and to invite other PLWHA to join the
support group. While advising them on their nutrition, tins of peak milk were distributed
to each member present.
May
Validation of the OVC forms commenced in the month of May as CBOs turned in all
completed forms and they were closely assessed. Forms that were not properly completed
were returned to respective CBOs and they were asked to correct the mistakes on new
forms.
Some of the challenges encountered in filling the forms include; Descriptive house
address, passport contrasting age of child on the form and HIV status. Others are; criteria
for enrolment and caregiver’s informations. Entering of forms into the permanent OVC
register for each CBO and Kid map also commenced this month.
Support group meeting also held in the month of May with nine members in attendance.
While making reports on their decision during the meeting in the month of April to invite
more members, Florence Mathew said that they were able to visit Mallam Tanko at home
to see how he is doing. Mallam Tanko was very happy to see them. She added that they
helped him to sweep his compound and after that, Elizabeth Thomas spoke to him about
how to manage his health and to ensure he adheres to his drugs properly. They also
encouraged him to try and make it to the next meeting.
Mary Aroh explained that after they left Tanko’s house, they decided to go to Mrs. Rachael
to see how she is fairing as part of their agreement to be visiting each other at least once
in a month.
For Rachael Paul it is actually a good development for members to visit each other; she
hopes this effort should be sustained. She also shared that sometimes, support group
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members start well but at the end, some members will not be committed because there is
no more support coming to them.
Justina Iyagba pleaded that the meeting should be holding on Saturdays as it will give
members that work during the week the opportunity to attend.
Responding to Justina, Tony said that SCD will look into that and get a suitable day that
would be convenient for everybody.
On the way forward, Mrs. Elizabeth suggested that more men should be invited to join the
group and SCD should help develop a constitution for the group. SCD should seek for more
support for the group.
Rachael suggested that meeting time should be in the afternoon because they would like
to do some domestic chores in the mornings before coming out.
Each member present got five tins of milk.
HIV prevention PE activities
Number of new A only
contacts made
Number if repeat A only
contacts
Number of new AB contacts
made
Number of AB repeat contacts
Number of referrals
Number of SBC materials
distributed
314
194
31
56
87
9
Number of home visits by Community Volunteers is 97 and 94 for Gwagwa and Jiwa
respectively.
In the month of June the OVC details were still being entered into the Kid map, this was
being done in CACA (Umbrella CBO) office.
Also in the month of June, on the 18th precisely, HAST management meeting was held.
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Speaking at the meeting, Amaka (CACA) said the aim of this meeting is to strengthen al lot
of weak points in the course executing and to discuss challenges and the way forward.
CBOs present at the meeting gave reports on their activities and the common issue that
arose at the meeting was the commencement of service delivery to OVC in the different
wards under FCT zone.
The first service which is birth registration commenced this month. Each CBO was given a
date when the FHI and CACA team will visit their ward for OVC birth registration and HCT
at the point of birth registration. CBOs were admonished to mobilize OVC previously
registered to come out for this exercise.
On the 23rd of June, it was the turn of SCD to register the birth of OVC in Gwagwa n Jiwa
ward. OVC and caregivers were mobilized for this exercise. However, absence of the
names of a lot of OVC previously enrolled in these wards on the register that was used for
this exercise was a great challenge.
Stigma Reduction meeting also held in this month of June with traditional leaders,
religious leaders, Community Volunteers and CBOs in attendance. The venue was Garki
PHC.
The monthly support group meeting has become a tradition in SCD which she is happy
with and always ready to improve. In this month of June, support group meeting held and
issues that came up at the meeting include;
 Some PLP in Jiwa are afraid to disclose their status because people stop buying
things from them if they are traders.
 PLP agreed to mobilize other PLP who are interested to join the group.
 Most of the support group members said they are receiving their drugs from
Institute for Human Virology at Idu NIPRD
 Two women said that their children are also positive but they are also on drug
 PLP still have the phobia of stigma
 PLP still find it difficult to disclose their status.
Elizabeth Thomas urged that members should ensure that they keep good health by
keeping their environment clean and eat good food. Tony also admonished them to
continue to look out for the interest of one another and act as source of
encouragement in the community. Mary Aroh thanked SCD for calling them together
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monthly discuss burning issues.
The M & E report of this month showed that there is improvement in the work of SCD via
their Community Volunteer and Peer Educators.
HIV prevention PE activities
Number of new A only
contacts made
Number if repeat A only
contacts
Number of new AB contacts
made
Number of AB repeat contacts
Number of referrals
Number of SBC materials
distributed
658
223
20
121
11
11
CBO MONTHLY SUMMARY FORM
Gwagwa
Jiwa
No. Of active community volunteer registered with the CBO
3(2M, 1F)
2(1M, 1F)
No. Of home visits by community volunteers
306
112
No. Of ART patients 1-14yrs receiving treatment support for the first time from CV
4(1M, 3F)
0
No. Of ART patients 15yrs and old receiving treatment support for the first time from CV
4(1M, 3F)
0
No. Of TB patients receiving treatment support for the first time from CV
`
10(8M, 2F)
11(5M, 6F)
No. Of clients receiving care and support (excluding ART&TB treatment support) for the first time from CV
0
10(6M, 4F)
No. Of OVC receiving support for the first time from CV
33(15M, 18F)
15
61(34M 27F)
Evaluation
During a visit to Gwagwa and Jiwa ward to evaluate the progress of HAST activites, SCD
gathered that from January through June, the Health facility in Jiwa conducted 188 HIV
test with three coming out positive. They are now receiving treatment. While giving this
information, Musa; a health officer in this facility said that community people now come
out freely to run HIV test which was not the case previously. He also said that the HAST
program is really enriching the lives of the community people directly and indirectly. As a
result, they are now more conscious of their health and the free testing and treatment of
HIV/AIDS, STI and TB gives them joy.
On STI, Musa said any STI that cannot be managed by the facility is referred to Wuse
General hospital for treatment. The National Guideline on the syndrome of STI and other
Reproductive Tract Infections (RTIs) is used for diagnosis and test.
Mrs. Kolawole who is the health Officer in charge of the facility said though they get cases
of STI and HIV, they treat the STIs and for HIV, they run tests, counsel them and send them
to centres where they can access treatment and support. She also added that the forms
given to the CVs are too cumbersome, filling it takes time so alternatively, they fill the
ones they can and leave the rest. When asked about the response of the community
people towards the HAST project, she said that the voluntary counselling and testing has
really helped the community people who are now turning up for testing, those who tested
positive are taught to live positively which they accept in good faith.
Mrs Kolawole responding to questions from an SCD staff
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Abduraman Rabiu and Idi Rabiu are OVC enrolled by SCD in the just concluded OVC
enrolment in April. The care giver of these children said they lost their mother few years
ago and she was asked to take care of them. When asked her relationship with these
children, she said that she is their aunty. Married in Jiwa with her own kids, sometimes she
finds it difficult to attend to the needs of these kids. They are in school but they still need
support because paying their fees sometimes is a great challenge. She appreciated the
work being done through SCD and pleaded that support be given to her to enable her give
the children the best.
Abduraman & Idi Rabiu with their Aunty Zainab
Jamila & her Caregiver
Jamila Dangana is a primary 3 pupil of LEA primary school in Gwagwa. Little Jamila who
was four months old when she lost her father eight years ago works for people to earn
money to pay her fees. Jamila’s mother is now married to another man who does not see
taking care of Jamila as a priority. Jamila said she looks forward to a bright future. How
can Jamila get to her beautiful and bright future without the timely intervention of the
services for OVC?
Though not a true child of the household made up of fourteen children, Adamu Dahiru
popularly called Babangida has no better option but to live with his uncle in Gwagwa As a
complete orphan who lost both parents two years when he was 6yrs old, Babangida looks
forward to getting help from CBOs and good hearted individuals to see him through school
or to learn a curative hand work that will earn a living for him in the nearest future.
Maimuna Haruna is the mother of Shaibu and Halilu Haruna. She lost her husband who has
17
been ill for several years three months ago. Maiuna thinks life has not being fair as she is
not educated and do not have the capital to start any good business but to sell pap every
morning. Her husband s has other wives and each of them have their own challenges.
Maimuna looks forward to receiving help as a form of service delivery from the OVC
enrolment soon as this will help het put Shaibu who is 4years old in school.
Babangida & his caregiver
Maimuna and her kids
CHALLENGES IN THE HAST PROJECT
 Hajia Jummai Tanko, a Community Volunteer in Gwagwasaid that there is no near
laboratory for Tuberculosis patients, the Wuse centre is not very accessible to the
patients, it takes some 7-10 days before they are attended to, some get upset and
never return, so they now go to Idu centre where they are sure of being attended
to.
 People living positively are asking for more support especially those without
means of livelihood.
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1Ma'azu, Jummai & Comfort (CVs) in a meeting with SCD
 Those that were registered for OVC are asking when they can start receiving
support. Some are out of school and do not feed well, care givers are scared of
child hawking due to the rampant abuses seen. The OVC also need mosquito nets.
 Comfort Sunday, a CV in Jiwa reported that community people are demanding for
money and support for the data of their children taken, the community
volunteers are being accused of taking the money meant for the OVC and wanting
to use their pictures for rituals.
 Muazu Mohammad also a CV in Jiaw said that some registered OVC did not see
their names in the list of those to be given birth certificates. He also reported that
there is a communication gap between the community volunteers and the Musa,
a Health Officer in the primary health centre, he goes for meetings and does not
step down training to the CVs and does not carry them along. In addition, politics
hinders CVs efforts in working; parties that are at logger heads do not like seeing
some people in their Counterparts Company or house.
 The Chief in Gwagwa ward also expects money to sign the OVC forms saying that
there is money for the workers.
BENEFITS OF THE HAST PROGRAM
Given a supportive policy environment and commitment from community leaders, LGA
and state health authorities, HAST can:
• Increase uptake of HCT STI and TB services
• Reduce stigma and increase access to HIV/AIDS care treatment and support
services
• Increase the case detection and the cure rate of TB, including the MDR-TB
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• By using an integrated approach, verticalisation of individual disease programs as
currently practiced at higher service levels can be avoided at LGA level.
• Synergies can be utilized while duplication of health management and service
structures can be reduced.
• In this way, the HAST model can be adopted as a central component of an
effective and efficient disease control program in Nigeria.
SUCCESSES
 Community members are more sensitive to health issues and inquisitive to know
their HIV status.
 Mallam Isa in Jiwa successfully completed his DOT treatment and is confirmed
free. His family members were also referred and were confirmed TB free.
 Birth Registration of OVC.
 Some OVC now know their HIV status.
 The OVC and caregivers have something to look forward to.
CONCLUSION
When a program is in progress, it is very important to look back and assess the impact of
the program. From this report, SCD realised that a lot has being done since the month of
January and stepping into the second half of the year 2010, SCD has made a resolution
to do more but not without the support of FHI/GHAIN and CACA.
The monthly support group meeting has affected the lives of PLPs positively. And OVC
have hope that in the near future help will come.
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