Strengthening the community contribution to health systems – the case of autonomous MSM and PLHA service organizations in China
W. Yang, H. Wang, G. Smith
International HIV/AIDS Alliance in China, Kunming, China
Issues: CBOs have a critical role to play in enhancing the effectiveness of health system responses to HIV/AIDS. VCT coverage and ART adherence are a case in point. The systems development needs of CBOs providing such enhancements are often overlooked.
Description: With support from USAID and DFID the International HIV/AIDS Alliance has been building the institutional capacity of the Chengdu Gay Care Organization (CGCO) and AIDS Care China (ACC.) Both groups are unusual in China in that they are commercially registered, community-led and independently governed. Their services are highly integrated into local government clinic and hospital-based services. In 2009 CGCO reached over 1,000 MSM in Chengdu with VCT, accounting for 88% of the number of identified MSM getting tested and 87% of those testing positive. ACC operates a healthcare facility-based peer ART adherence support service across 4 provinces. Among 2037 on ART receiving support in 2009 in 3 sites in Guangxi province they recorded loss-to-follow-up rates less than 1% (16 persons, exclusive of 119 deaths and 48 discontinuing for medical reasons.)
To help develop these groups’ contribution to the health system Alliance has provided organizational development support on financial management systems, M&E systems, programme planning and organizational strategy development. This support is essential to sustain these interventions and help them go to scale.
Lessons learned: In the Chinese context PLHA and MSM CBOs can have significant social space to develop and govern their organizations independently if they work alongside public health authorities to a public health agenda. Collaborative (government/CBO) service delivery models enhance government support for CBO involvement which in turn helps tackle low demand for clinic-based VCT and poor adherence to ART.
Next steps: Sustainability is a critical issue as international funding for HIV programmes in China decreases. In-country funding for local CBOs is essential to build on these successes.