Love thy neighbor: Tanzanian communities mobilize their own for HIV testing and care
“I’ve always heard people talk about ‘community engagement’ and ‘community mobilization’, now I see, this is the real way to do it,” said Regina, the District Home-Based Care (HBC) Coordinator of Muheza, while meeting with the community improvement team in Kwemsala. This comment struck me when she said it, and now, weeks later, I continue to think about it and the work that I saw when I visited communities involved in the Tanzania Community Linkages activity in the Tanga Region.
Based off of the Community Health Systems Strengthening Model, USAID ASSIST, in partnership with the Ministry of Health and Social Welfare (MOHSW), formed community improvement teams in five communities to address low uptake of HIV testing and loss to follow up in HIV care and treatment.
The community teams were formed by picking a member from each existing community group (including PLHIV groups, savings groups, religious groups, etc). These members, along with the community home-based care (HBC) volunteers, meet regularly to discuss health issues in the community, with the HBC volunteer sharing information from the facility (such as number of community members who went for HIV testing in the last month). When these same community members meet with their other community groups, they spend one hour of those meetings discussing health issues and ask members to go to their families and advocate for them to go to HIV testing, or if they’ve stopped treatment, to go back on it. It’s a relatively simple concept that is making a real difference in people’s lives.
When I met with the community groups, they were eager to tell us how they had mobilized their friends and family members to go to HIV testing, even getting their health facilities to bring HIV testing into the community, increasing access for people who could not travel to the facility. They also talked about the reduction of stigma around testing. Before, they said, the majority of people testing for HIV were pregnant women and people who were ill. Now, understanding has improved, more men are getting tested and people aren’t waiting until they are sick. As one community team member in Enzi said, people now think of HIV testing as normal.
I think there is a big difference between being told to go for testing by a doctor or in a large group setting versus having that message come directly from your family members because they love and care about you. Community team members all shared the sense of pride they feel, doing this work. They said they are caring for the health of their communities that people in the community need to be in good health for the development of everyone.
The HBC volunteers spoke about their reduced work load and tighter connection with the community. At the facility, providers talked about increased uptake of services and better understanding of the communities’ needs.
At Kilulu dispensary, the nurse said that this model works because the team reaches everywhere, thus enabling information to spread quickly and easily. Regina, at the district level, said that she used to visit the health facilities and the HBC volunteers to find out what was going on, now she meets with the community teams. She said she sees that things are working and that members are motivated.
I left the communities feeling reinvigorated and motivated with a strong sense of having seen, as Regina said, true community engagement.