The Peers to Zero (P2Z) Coalition aims to empower adolescents and young people living with HIV (AYPLHIV; ages 10 – 24 years) to advocate for and secure their rights whilst promoting enabled health facility environments. In this way, we strive to improve their access to effective treatment and care. P2Z Local Forums build on the PATA-AY+ Youth Summit that took place in Dar es Salaam, Tanzania in June 2016, where the P2Z Coalition was launched. While the Youth Summit focused on AYPLHIV engaged as Peer Supporters, the local forums focus on healthcare providers who work with AYPLHIV daily.
The first “P2Z Local Forum – Healthcare provider sensitization for adolescent friendly services” was held in Zimbabwe in October 2016, with eight facilities in attendance. Subsequently, two more P2Z Local Forums have taken place, in Malawi in November and Uganda in December 2016, with six and five facilities attending respectively. The objectives of the forums are to create awareness of the attitudinal and organisational issues affecting the delivery of adolescent-friendly health services (AFHS), to increase participants’ knowledge and skills in working with AYPLHIV, and to promote AFHS through the development of quality improvement plans.
For the most part, the three-day forums focus on healthcare provider sensitization, however, it is recognised that it is not possible to understand AFHS, without input from AYPLHIV themselves. Therefore, in addition to the two healthcare providers that attend from each health facility, a peer supporter from the facility attends with them. Healthcare providers follow a structured workshop process, covering topics ranging from how to work with, engage and communicate with AYPLHIV, and how to support them to realise their sexual reproductive health and rights (SRHR), to creating a safe and support environment and empowering AYPLHIV. The workshop process is participatory, with individual and group exercises.
While healthcare providers workshop on days one and two, peer supporters have their own activities and schedule. Together, peer supporters go on an exchange site visit to another PATA affiliated facility. There they join their fellow PATA peer supporters in their daily tasks, to get an understanding of what their colleagues are engaged in at their facilities. On day two of the forum, peer supporters take part in their own workshop process with representatives from the national network of AYPLHIV from the respective countries. The focus of this session is to understand from peer supporters/AYPLHIV what they require from health services provided to them in order to be considered adolescent-friendly, and how they would like to be better engaged in service planning, implementation and evaluation.
On the third and final day, peer supporters and healthcare providers come together to share what has been discussed and learnt, and to develop a quality improvement plan. These plans form the main output of the forum, and are designed by peer supporters and healthcare providers together, with the aim to:
1) Improve the quality of adolescent-friendly services provided at the facility, and
2) Strengthen AYPLHIV engagement in HIV treatment and care so that they express their opinions and be more active in decisions that affect them.
Quality improvement plans focus on one of three themes:
Support groups: Led by ALHIV, to address different patient needs and reach different groups (e.g. groups for presenting well/presenting unwell/stable/unstable youth)
Peer-led service delivery: Integration of ALHIV in supporting treatment or care services (e.g. engagement in service delivery, peer counselling, prevention programmes, and linking SRH-HIV treatment)
ALHIV engagement in service feedback and monitoring: Mechanisms that allow ALHIV to be heard and have an opportunity to continuously impact and evaluate services (e.g. patient scorecard)
The local forums have been an excellent opportunity for health provider and peer supporter/AYPLHIV engagement around AFHS. A common theme that emerged from the forums that have taken place is that there is often an assumption that having AYPLHIV engaged as peer supporters, and providing services to adolescents means that a facility is adolescent-friendly. There also tend to be differences between what AYPLHIV/ peer supporters and health providers think are essential to a basic package of care provided to AYPLHIV: what these should include, who provides them, and how the services feel and work together. In this respect, bringing together these two groups has been hugely beneficial and has contributed to the sensitization of healthcare providers around AYPLHIV, the services they receive, and where they can and should be engaged in service design, implementation and assessment.
There are four more countries in which forums will be launched in 2017, namely Kenya, Swaziland, Tanzania and Zambia.
For more information about Peers to Zero, contact PATA Programme Manager Heleen Soeters at firstname.lastname@example.org.