Why Communities Must Be at the Center of Differentiated Service Delivery

This week, on 12-13 February 2018, ITPC participated in a meeting for The CQUIN Learning Network: Partnering to Advance Differentiated Service Delivery hosted by ICAP at Columbia University.
ITPC Executive Director Solange Baptiste spoke at the opening reception on Monday evening and presented at the first session of the week, helping to elevate the role of communities in the planning, design, and implementation of differentiated service delivery (DSD) models. Her speech (available below) and presentation (titled What Works for Me: A Community Perspective on Differentiated Service Delivery) highlighted the need for communities to be at the center of all DSD work.

Opening Speech – CQUIN Meeting

February 12, 2018 at 6pm

The Polana Serena Hotel, Maputo, Mozambique

Honorable Minister of Health, Dr. Abdula, esteemed members of the panel (all protocols observed), ladies and gentlemen, good evening.
Thanks to the CQIUN Network, I have the great privilege to be here with you to reflect on how far we have come, where we are today and how far we still need to go to ensure that quality HIV services reach all that need it through differentiated service delivery.
My name is Solange Baptiste and I lead a global coalition of activists who work to ensure access to treatment for all people living with HIV, called, the International Treatment Preparedness Coalition or ITPC.
ITPC, in collaboration with many national and community partners, along with ARASA, ICAP and the IAS, has been working over the past few years to ensure that DSD does not reside in Geneva or in government policy papers, but that it really responds to the needs of people who rely on and use the health system. Our collective efforts include direct work with communities to understand, demand and advocate for the appropriate scale up of quality DSD in their countries.
As I look around the room, I see public health experts, researchers, government officials…essentially DSD gurus! So, what can I tell you that brings a different perspective to your mind, to this week?
Let me tell you about Dora. Dora is a 20-year old, undocumented, Zimbabwean woman living with HIV in Botswana. Dora is a sex worker and attended one of our DSD workshops for community leaders. Dora, who was shy in the meeting but very confident otherwise, approached me at the tea break to let me know that she was very perplexed about this “DSD thing!”. She asked me “what is there to differentiate if there is no service for people like me!” She hit the nail on the head. To differentiate or specialize a service means that one must already exist for that population, and if not, you are forced confront why there is none.
If we are honest, DSD forces us to confront the health system head on. To tackle DSD is to tackle the health system. We face questions like what makes the health system weak? What makes the health system fragile and not work for those who need it? To look at overcrowding, stock outs and bad services is to look at poor infrastructure, dwindling resources, no political will and systemic discrimination.
In the context of test & treat and increased treatment coverage, we applaud governments, like Mozambique, who despite challenges, figured it out… and expanded treatment coverage for pregnant women living with HIV resulting in a 73 percent decline in new HIV infections among children from 2011 to 2014 and reduced new HIV infections among adults by 40 percent from 2004 to 2014.
In conversations with community leaders…from all walks of life, adolescents, people using drugs, migrants, heterosexual men, people with disabilities and others… one theme was constant as they discussed DSD… communities must be at the center for this to work… (and how cliché is that?!). But the crux of the matter is HOW? How and when are communities involved? Communities must be there at the start and be part of the team to design models and programs, plan them, implement them, monitor them, reprogram them and scale them up. They must be paid to do this work and seen as valued voices at the decision-making table.
So, as we prepare to spend the rest of this week dissecting aspects of the rollout and scale up of DSD, I would like to remind us to constantly consider 3 things:

  1. How can DSD be operationalized so that communities are at the center of design, planning and implementation?
  2. How do we ensure that those who are not in the system are reached through DSD interventions? And;
  3. How do we ensure that differentiated services provided along the cascade are of optimal quality for the recipients of care?

THANK YOU

To learn more about ITPC’s work on differentiated service delivery, download What Works for Me: Activist Toolkit on Differentiated Service Delivery (Available in English, PDF and French, PDF)