CAPACITY BUILDING FRAMEWORK: Facilitating the effective implementation of the community – Led monitoring and Engagement Framework

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Communities can play a catalytic role in improving health outcomes, service delivery, and overall quality of life and understanding of health within communities. The involvement of recipients of care—and other affected communities—in monitoring their health systems is essential. PEPFAR recognizes the importance of engaging communities in the development and implementation of its programming. As PEPFAR continues to confront the challenges of assuring retention on life-long ART in PLHIV who may not view themselves as sick, collaboration with communities and PLHIV is urgent and critical. This collaboration can help PEPFAR programs and facilities ensure they are providing quality services that beneficiaries want to utilize. Collaboration with community groups, CSOs and PLHIV or beneficiaries can help PEPFAR programs and health institutions diagnose and pinpoint persistent problems, challenges and barriers with service uptake at the site and facility level to effective service and client outcomes at the site. Most importantly this collaboration identifies workable solutions to overcome barriers and ensure beneficiaries have access to services. One approach to this kind of collaboration has been variously referred to as Community Led Monitoring (CLM) among others. The Sustainability Index Dashboard and Responsibility Matrix 2019 indicated poor performance, poor quality of services, poor health workers’ attitudes, health and rights violations, and frequent stock-outs and/or shortages of diagnostics and treatment commodities. While HIV treatment and prevention coverage has steadily improved in Uganda, there are persistent shortcomings in the response. These include; high rates of loss to follow up (LTFU), limited uptake of high impact prevention services such as PrEP, high rates of discontinuation from the DREAMS program, limited access to ‘friendly’ services for HIV positive and HIV negative adolescents/youth, high rates of stigma and discrimination, poor provision of prevention and treatment services for KPs, low community/service recipients’ participation in planning, monitoring and evaluation. Additionally, there is very poor viral load suppression among some groups (paediatrics, pregnant women adolescents, men > 25). As well community and social factors such as stigma, gender and sexuality discrimination, and other social barriers exist. PEPFAR and its IPs have made great progress to realize over 1.2 million on treatment and over 75% virally suppressed. However, there is still need to find the remaining 150,000 HIV infected individuals, link them to treatment and retain all those PLHIV on ART. There is also need to avert new infections especially among risk populations.