A Powerful Combination

Reaching challenging populations by integrating services under a social franchise brand

By Stephano Gudukeya, PSI Zimbabwe

This year’s AIDS Conference has been a whirlwind of activity and information.

One topic that has come up time and again is linkages and the challenges involved with connecting people to the services they need.

It seems like a no-brainer – when services are integrated, it’s easier for people to get the healthcare they need. This means we can more easily keep people in the healthcare system and improve their overall health and well-being.

We’ve found that integrated services are particularly useful in reaching key populations.

At PSI Zimbabwe, and throughout the PSI network, we provide integrated services to some of the most challenging-to-reach populations through social franchising.

Using commercial franchising techniques – similar to a McDonalds – we work with clinics and facilities to join a branded network, ensuring quality, standard services, etc.

In Zimbabwe, the PSI-affiliated health franchise New Start provides an array of integrated services for some of the most challenging to reach populations.

For example, New Start agents go to work places – manufacturing plants, farms, mining towns – to test men there, where they are. Ninety-five percent of the clients receiving inter-personal counseling at workplaces end up getting tested for HIV. All eligible males are also given information on voluntary medical male circumcision and referred for the service if they are interested.

The strategy has worked to bring in this difficult to reach population for Zimbabwe, who are often stubborn about receiving medical attention. In Zimbabwe, nearly twice as many women get tested for HIV than men overall, but half of New Start’s clients are men.

If clients do test for HIV and are diagnosed as HIV positive, they are able to access point-of-care CD4 cell count tests to find out the “health” of their immune system rather than having to return later or go elsewhere. This near-instantaneous response ensures that people get onto treatment courses at the right time.

Everyone is also screened for TB during New Start visits, and six locations do TB diagnosis. Centers also integrate cervical cancer screening for women, regardless of HIV status.

All New Start clients receiving family planning services are also offered an HIV test and cervical cancer screening, and all women coming for HTC are counseled on family planning. Overall, New Start locations see about 12,000 clients per month for family planning services.

New Start has also expanded family planning services to the public sector through affiliated ProFam clinics. PSI Zimbabwe trains health providers in the public sector, supports quality assurance at their facilities and ensures a steady supply chain for family planning commodities. ProFam is also marketed as an affordable option, aimed at providing comprehensive market coverage.

New Start clinics have also integrated anti-retroviral therapy into our program targeting specific key affected populations, such as female sex workers, HIV serodiscordant couples and TB/HIV coinfected individuals.

Survivors of gender-based violence are another often challenging population that New Start franchisees serve. Seven sites (soon to be eight) provide counseling, emergency contraception, post-exposure prophylactic treatment for HIV, other STI prophylaxis and treatment, as well as referrals for legal services. New Start’s GBV-survival services include forensic exams for rape survivors in case they decide to take their case to court.

Since February 2013, New Start franchisees, working in partnership with Family Support Trust and the Adult Rape Clinic, have seen about 1,500 GBV survivors for these services. A mass media campaign has three main objectives: 1) Getting rape survivors to access services within 72 hours of a rape and informing them where to go; 2) ensuring that survivors realize that they are not to blame for the sexual violence that has been perpetrated against them; and 3) challenging negative gender norms that drive sexual violence and leave many survivors without the social support they need to recover.