Seeking support for continuum of care project in Manipur

[Guest guest]

Dear Forum,

All of you might have well aware that the HIV epidemic in Manipur is steadily

escalating with multiple issues of health, socio-economic and political. It is

also quite evident that the trends of HIV infection have shifted from the

specific target communities to the general population and consequently we are

observing the increased number of infection among the women and children. Now

the situation becomes more complicated and unmanageable since the sudden

escalation of symptomatic illness, deaths, widows and orphan children.

Everyday, we have witnessed or heard about the deaths of our beloved friends,

brothers and sisters either in the hospital or in the community. It is also fact

that many people are compromising their health for a piece of meal.

As Manipur being a poor state, the resources are limited and could not address

the emerging felt needs of the PLHAs . It may be also mentioned that there are

limited number of NGOs that are extending care and support services for our

people.

From the lesson learned of the past experiences it is observed that an effective

HIV prevention is meaningless where there is no facility for care and support

service But the existing services which we are extending to our people are also

to be discontinued in near future as funders withdraw their support to the North

East Region.

But we strongly felt that still we need your support since Manipur is one of the

most vulnerable regions in the country. Further, I would like to mention that

still thousands People Living with HIV/AIDS are getting support directly and

indirectly from that programme. If the existing services are stopped suddenly

there will be a huge gap in the provision of care and support services for our

beloved positive friends, brothers, sisters and children. Women SHGs are not

even sustained and still needed our further support. The situation in Manipur is

like a disaster. There is a need for immediate relief measures to mitigate these

growing issues.

Being initiated as an extended programme of Oxfam, COCP has added to the

credibility of Oxfam as COCP was included One of the Eight Best Case Studies of

Home and Community Care for and by people with HIV/AIDS, published by UNAIDS,

September 2001. In addition this model of project has been replicated in the

different parts of the country. We do not like to lose this credibility in any

cost.

Keeping in views of these reasons I am requesting to the members for your

technical support for the continuation of the existing COCP progamme.

Hoping a positive responce from the members.

With warm regards

K. Rajen Singh

Project Manager

COCP, Manipur

Encl. A brief note of COCP for your kind record and reference.

INTRODUCTION:

The HIV epidemic has been shifted from specific target group to the general

population. No. of new infection symptomatic patients deaths widows & orphan are

on rising. But still the people infected and affected by epidemic do not have

access to the care they need. People in resource poor region like Manipur are

having particular problems in getting access to quality care and support

services. The impact of the epidemic has resulted tremendous economic pressure

on PLHAs & their families. In view of these issues encountered by PLHAs, it was

felt the need for promoting a collective effort for enabling to address the

varied issues of HIV/AIDS as well as for maximizing the services for People

Living with HIV/AIDS.

Thus, the Continuum of Care Project was launched on 20th October 1994 at

3(three) project sites of Manipur namely Imphal (a Capital City), Kakching (a

rural town) & Churachandpur (a hill town of 8 ethnic groups) with Joint venture

of Govt. of Manipur, NACO, OXFAM, WHO, British Council and representative of 28

local NGOs as a Pilot Project.

STAKEHOLDERS:

Primary Stakeholders:

1. IVDUs.

2. Spouses of IVDUs.

3. PLWHAs

4. Partners, spouses & family members of PLWHAs

5. Women & Children of infected and affected by HIV/AIDS.

6. CSWs.

7. Migrant laborers.

Secondary Stakeholders:

1. Health professionals of Government and Private Institutions.

2. Community leaders.

3. CBOs/NGOs.

4. FBOs.

5. Welfare and development agencies. (Govt./ Non-Govt.)

6. Political leaders.

7. Human Right Agencies.

OBJECTIVES:

· Providing comprehensive care to people living with HIV/AIDS.

· A continuum of care, linked with a referral system spanning

home and hospital.

· Integration of this model of care into the existing health care

system.

· Forging a close coordination and cooperation between NGOs and

govt. Heath services and communities.

· Inclusion of prevention component.

· Utilization of traditional and alternative care patterns and

available resources with provision of necessary sustainable

support mechanisms.

MAJOR ACTIVITIES:

1. Networking:

The project has successfully made linkage at three level viz. (1) Govt. Health

institutions (2) NGOs working in the field of HIV/AIDS and other welfare

services. (3) CBOs/local clubsand community leaders and faith based organization

at community level to avail a continuum of care for PLHAs. Regular dialogue and

meeting have been conducting since 1994 to avail appropriate and quality care to

PLHAs. All the meetings are facilitated by COCP

a) Formed hospital core groups at different Health Institutions of Manipur

Hospital Core Groups:

i) J.N. Hospital Core Group, ii) RIMS Core Group, iii) TB Hospital, Imphal

iv) TB Clinic Core Group, iv) CHC Kakching Core Group, v) Dist. Hospital

Churachandpur Core Group,

Ngo Core Groups:

i) NGO Core Group, Imphal ( the NGO core group become a network as MNCC)

ii) NGO Core Group, Kakching, iii) NGO Core Group, Churachandpur

c) Community Core Groups:i) Community Core Group, Imphal, ii) Community Core

Group, Kakching, iii) Community Core Group, Churachandpur

2. Operation of Service Cells/ Counselling Cells:

Service Cells / Counselling Cells were initiated for integrating the continuum

model of Care into the existing health institution in three project areas. At

present such cells are operating at J.N.Hospital, Imphal T.B. Hospital, Imphal,

RIMS STD Clinic, Imphal, District Hospital, Churachandpur and Community Health

Centre, Kakching, Thoubal Dist. Main activities of this service cells /

counseling cells:

· Guidance to the general patients

· Preventive counselling

· Pre and post test counsilling

· Ongoing supportive counseling

· Lost and bereavement counselling

· Counseling at the bedside (ward visit)

· Referral

· Wart visit

3. Prevention & Control Of HIV/TB Co-Infection

Dots:

Cocp has opened four (4) DOTS centres in collaboration with Youth Clubs & State

T.B. Clinic, making available TB medicines within the community.

4. Care And Support:

The project has made close linkage and partnership with different stakeholders

to maximize the care and support services for PLHAs. Counseling services are

provided at institutional level as well as at the community level. Staff and

community mobilisers are paying visits to the residence of the PLHAs and where

patients and their families are taught about nutrition, personal hygiene and

nursing care. The project is also trying to explore other welfare services

particularly for women and children infected by the HIV.

Ø Referral.

Ø Psycho-emotional support.

Ø Home Based Care.

Ø Medicine support.

5. Condom Promotions And Distribution:

Information on proper uses of condom (with demonstration) is given to the

high-risk individual while giving counseling services. Condom outlets are open

in the service cells / Counseling cells.

6. Development Of IEC Materials:

6.1. Resource Directory:

By the development of this Resource Directory, PLHAs and their families can

easily

access to the available services within the Community as well as at

Institutional level. And it also enhances referral services.

6.2. Home Care Handbook:

The Project has developed a Home Care Handbook for use of reference in

providing home base care more than 6000 Copies printed in English and Manipuri.

6.3. Training Manual:

The Project has developed a “A Manual for Trainers”. It helps to develop the

skills of different stakeholders of the project in delivering a comprehensive

care for PLHAs in the Community.

7. Capacity Building Of Stakeholders:

Trainings:

· Nursing & Palliative Care / Home Based Care.

· Outreach Communication & Counselling.

· Gender Issues.

· Sexual health.

8. Establishment & Formation SHG:

..1. Formation of SHG:

The project has so far facilitated in forming four (4) Self Help Groups:

1. Manipur Network of Positive People (MNP+).

2. Involvement of Community for Human empowerment (ICHE)

3. Maromdom Ngakcha Apunba Lup (MANGAL)

4. Vision Amidst Reality (VAR)

8.2. Mainstreaming HIV in development:

1. I.G.P. (Vocational training)

9. Promotion On Recognition Of Rti/Sti:

One counseling cell has been initiated at STD Clinic RIMS promoted safer sex

practices among the RTI/STI patients. Information on RTI/STI and proper uses of

condom are integrated in the community programmes and all the training

programmes.

PARTNERSHIP AND ALLIANCES

· Govt. Health Institutions - 6

· Govt. Welfare Dept. - 2

· Manipur State AIDS Control Society (MACS) - 1

· Non-Govt. Organisations - 28

· Community Based Organisations - 300

· Faith Based Organisations - 25

SUCCESS:

1. The Continuum of Care project Manipur was selected as one of the best

practices, in providing a continuum of Care (Home Base Care), it was published

as the best practice in the UNAIDS Best practices case study report in Nov.

2001.

2. The model has also been projected in the, “Global HIV epidemic 2002” UNAIDS

publication of the Barcelona meet, chapter 6 page 154 .

3. The Model has been replicated in Maharastra, Chennai & other District of

Manipur. To name a few TISS (Tata Institute of Social Science Mumbai),

Safdarjung Hospital Delhi,

4. NACO recently took up home base care and COCP’s model as an integral

component of the National AIDS prevention and control policy

5. Dialogue between all major stakeholders lead to change of attitude among care

provider, particularly health institution

6. Increasing No of HIV+ persons are seeking service, publicly discussing their

risk behaviors & sero-status, joining SHG group.

7. The project has successfully facilitated in forming a network as “ Manipur

Network for Continuum of Care” (MNCC) under a common vision, mission and

objectives to address the various issues of care and support to the PLHAs.

8. The Project has enable to bring close co-ordination among the NGOs as well as

between the NGOs & Health Institutions.

9. The project has success in sustaining the vocational cum childcare centre for

women and children by taping resources from AR Civic Programme and Community.

10. By advocating the authorities of Theological College, the project has

successfully changed the policy & practices of that Institution.

CHALLENGES:

· Continued drug abuse.

· Ethnic conflict.

· Law and order problems.

· Gender sensitization on sexual health is yet to be fully realized in the

present setup.

· PLWHAs are still stigmatized and still discriminated.

· Lack of legal awareness among the PLWHAs.

· Rapid escalation of symptomatic illness, deaths, widows and orphan children.

· Limited beds, poor infrastructure and lack of bio-safety materials in the

health institutions.

· Welfare schemes of government could not easily available to the beneficiaries

due to limited resources.

· Income generating program for positive women along with vocational training is

needed to empower them.

· High expectation from the project i.e. Clinical Care, Medicine & Financial

Support.

· High demand of OIs and ARV Drugs.

· There are limited number of NGOs & FBOs involved in the aspect of care and

support services. The existing services could not meet the multiple issues of

HIV/AIDS.

LESSONS LEARNED:

· FBOs saw tangible benefits being provided to a community in need and sought

through their initiatives to establish programme in their own community

· The acceptance of the programme by the family members and community leaders

greatly increased general support.

· Stakeholders realized the need for making partnership and alliances.

· Through networking with different stakeholders, enable to maximize the

services for PLHAs in the provision of “continuum of care”.

· The existence of the Service Cells/Counselling Cells, not only strengthening

the VCTC, but also creates a common platform for community, NGOs/CBOs and Govt.

· The formation of SHGs leads the PLHAs to positive living and come forward in

fighting the challenges.

FUTURE:

· The project is planning to initiate a model community counseling centres at

the community in collaboration with the local clubs.

· Scaling up of the present activities.