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Image: JAMAICA | (l-r) Tameka Clough (Jamaica Country Programme Coordinator, HP+), Dr Jennifer Knight-Johnson (Acting Director for Environment and Health, USAID), Rebecca Robinson (Acting Mission Director, USAID), Sandra McLeish (Jamaica Country Programme Director, HP+) and Dr The Honorable Christopher Tufton, Minister of Health, Jamaica.

The Health Policy Plus (HP+) project presented Hon. Dr Christopher Tufton, Minister of Health, Jamaica with 100 copies of a Complaint Management System (CMS) Manual and Toolkit.  The CMS outlined clear processes for accessing, documenting, investigating and resolving customer complaints. It also included a monitoring and evaluation framework that ensured complaint data is captured for quality improvement activities and programme and policy development.

The manual was designed to be used by Ministry of Health (MOH) staff involved in the complaint management process at all levels, within health facilities, regional health authorities, health departments and the Investigation and Enforcement Branch (Standards and Regulation Division). The aim of the initiative was to empower MOH staff to provide clients with the necessary guidance on how to raise their concerns and complaints.

The production of the manual formed part of the Ministry’s ongoing efforts to strengthen its customer service initiatives with its increased emphasis on patient-centered care. The production of the manual aimed to improve quality of service delivery in the public health sector by driving the demand for users to raise their concerns and lodge complaints and collect feedback from internal and external clients on the delivery of services.

The initiative also aimed to provide guidance on the means for failures and or complaints to be investigated as well as provide information on corrective and preventative actions, track data and trends on complaints to inform programme and policy changes for development and provide redress to clients.

In 2015, the Standards and Regulation Division, which has oversight for the CMS, approached the Health Policy Project (HPP), the predecessor project to HP+, to strengthen the Client Complaint Mechanism (CCM), launched in 2000.  Through the technical assistance provided by HP+, the CCM has evolved from procedural steps to a Complaint Management System with the inclusion of Quality Assurance components.  It is aligned with the International Organization for Standardization (ISO) 9001, Quality Management Systems – Requirements (2008).

Ms Sandra McLeish, Jamaica Country Programme Director for HP+, is proud of the collaboration with the Investigation and Enforcement Branch of the Standards and Regulation Division and has indicated the potential for future collaborations to strengthen customer service. “Having a robust reporting and redress system will go a far way in increasing the confidence of clients of the health sector since it is evident that the Ministry of Health is taking issues of discrimination seriously. The Standards and Regulations Division of the Ministry of Health has partnered with us for more than three years in developing this manual and toolkit that will strengthen not only the reporting but the avenues for redress for users of the system,” stated Ms McLeish.

The Minister anticipates that “the manual will be a useful tool in standardizing and streamlining the Complaint Management System across public health facilities and will strengthen the Ministry’s efforts in the delivery of quality care. The distribution and implementation of the CMS Manual and Toolkit to public health facilities will also strengthen the Compassionate Care Programme which was launched earlier this year at the Victoria Jubilee Hospital.”

The United States Agency for International Development (USAID) was represented by Ms Rebecca Robinson (Acting Mission Director), Dr Jennifer Knight-Johnson (Acting Director for Environment and Health) and Ms Diana Acosta, the new Health Officer.

During the presentation of the Manual, Dr Knight-Johnson stated, “the initiative is a best practice, highlighting how PEPFAR resources are used effectively to address issues associated with stigma, discrimination and redress in country.  We recognize the work and effort beyond the call of duty that was put into ensuring that there is a trainers guide that accompanies the manual and that augurs well for sustainability. We also recognize the associated inputs and the level of effort involved with developing the case routing algorithm, the mystery client intervention and the Privacy and Confidentiality policy related to S&D”.

Image: JAMAICA | Representatives from the Bureau of Gender Affairs, HP+, Eve for Life, National Family Planning Board presenting the Comprehensive Package for Healthcare Workers and Providers to Mr Dunstan Bryan, Permanent Secretary, Ministry of Health, Jamaica.

In January 2019, the Health Policy Plus (HP+) project presented Permanent Secretary (PS), Ministry of Health (MOH), Mr Dunstan Bryan with a Comprehensive Package for Healthcare Workers and Providers to Address Gender-based Violence for clients of healthcare facilities in Jamaica.

The package constitutes several elements and is a culmination of years of work done under the project with Gender-based Violence (GBV).  It included a guideline document for healthcare workers and providers when dealing with known, suspected or potential clients who may be suffering from GBV.

The package also included a GBV Referral Directory with contact information for entities that provide GBV services including those for adolescence, information, education and communication (IEC) material in the form of a brochure with a self-assessment tool and a safety card, which is a small discreet card that can be kept by the client in case they need contact information for entities that provide GBV services.

The Ministry was also provided with “Recommendations for Mainstreaming GBV into the National HIV Response” and a Dissemination Plan for the material.

At the handover exercise, PS Bryan indicated that “he appreciates the work and help of the HP+ and agrees that the guidelines and materials are necessary to help not only staff but the public to combat GBV and HIV”.

Eve for Life (EFL) co-founder and Director of Impact, Joy Crawford, was the consultant for the project.  Eve for Life is a Non-Governmental Organization (NGO) founded in 2008, to support women and children living with or affected by HIV and AIDS.  EFL is seen as a champion for shaping a world where the sexual health and rights of young women and girls are protected and upheld.  The organization is involved in extensive work in GBV.

In 2004, the National AIDS Commission (NAC) Belize became a statutory body with a legal mandate for coordination, monitoring, advocacy action and policy development in relation to HIV and AIDS in Belize. Its Policy and Legislation Project then provided input into the National Policy on HIV and AIDS adopted in 2005.

The NAC’s constitution calls for the state to address the social and economic disparity between citizens and even acknowledges the need for non-discriminatory treatment in law by authorities. Differential treatment of women, children and other social groups in the workplace, school settings and communities calls for scaling up of Civil Rights legislation and regulations that examine standards for service delivery that affect the users of our health system who are impacted by socio-economic and civil rights issues that affect access to justice.

Without comprehensive HIV and AIDS laws, general anti-discrimination laws, or a human rights act to legally enforce non-discrimination against People Living with HIV (PLHIV), there will be challenges in ensuring equal access to prevention, care, treatment, and support by key populations, as well as the full enjoyment of PLHIV in all aspects of social, cultural, civil, and political life.

Hence, the NAC Belize has championed the cause of drafting an anti-discrimination bill based on the CARICOM Model Anti-Discrimination Bill. The bill aims to establish a comprehensive anti-discrimination law addressing multiple areas of discrimination in Belize.

The anti-discrimination bill is being supported jointly by Hon. Laura Tucker-Longsworth OBE, National AIDS Commission Chair and Ms Kim Simplis Barrow, First Lady of Belize, Special Envoy for Women and Children and Chair of the Spouses of CARICOM Leaders Action Network (SCLAN).

It is the goal of the NAC and its partners that by the end of 2019, Belize will have a robust and all-inclusive anti-discrimination law that effectively addresses stigma and discrimination.

The Total Facility Approach to S&D-reduction Project is a three-phase project commencing with the collection of baseline stigma and discrimination (S&D) data from both health care providers (HCP) and People Living with HIV (PLHIV) clients at three sites including the Kingston Public Hospital (KPH), Windward Road Health Centre (WRHC) and Savanna la Mar Public General Hospital (SPGH). It was implemented over the summer of 2017.

The findings were later disseminated to each site, and at a national dissemination meeting in September 2017.  The final report was finalized in March 2018.  The data and feedback from these meetings were then used to tailor facility-based S&D-reduction activities for each facility for the second phase which encompassed capacity building including the development of a facilitators guide for Jamaica titled “Towards Stigma Free Health Facilities in Jamaica: Western and Southern”.

The draft guide was then used to train staff of the KPH and SPGH, members from HIV-related Civil Society Organizations and staff of the National Family Planning Board Jamaica (NFPB) and HP+, using a Training of Facilitators (ToF) approach.

Training (which is the beginning of phase two) was conducted in S&D-reduction strategies using participatory methodologies over five days by Ayana Hypolite, Master Trainer/Counselor from RTI/Barbados and Joy Crawford, local Master Trainer and Co-founder and Director of Impact for Eve for Life.

The aim of the training was to strengthen the capacity of the co-facilitators with capacity building on the procedures, tools and expectations for S&D-reduction programming.  It was intended that the knowledge gained would be disseminated to staff of the three facilities.   The guide was then finalized with input from the newly trained co-facilitators.

The capacity-building phase also included a two-day roll out of training with at least 60% of the staff of each facility via Health Care Workers (HCW) and PLHIV lead trainings, with support from NFPB and HP+.  Three hundred and Fifty-eight (358) healthcare staff from the KPH, WRHC and SPGH, were trained in S&D-reduction strategies.

The last element of this phase of the project was the development of tailored policy interventions for each facility coming out of recommendations from the staff trainings and other observations.

After several consultations with staff, it was recommended that information, education and communication (IEC) material be developed for the policy intervention.  An e-poster, video and printable posters were developed and presented to the three sites.

Verification was subsequently done to ensure that either the poster or video was displayed in the three facilities to facilitate entry into the final and 3rd phase of the project, which was the end line survey.

This was to determine if the capacity building initiatives (both trainings and IEC material) instituted in the facilities resulted in a change in behaviour and hopefully a reduction in stigma and discrimination of clients.

The initiative was supported by United States Agency for International Development (USAID) and The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).

Image: Xavier Biggs, Monitoring and Evaluation Programme Officer, Jamaica AIDS Support for Life (JASL)

The Jamaica AIDS Support for Life (JASL) E-Learning initiative is the organization’s response to the need for capacity development among its staff cohort.

Xavier Biggs, Monitoring and Evaluation Programme Officer at JASL recently spoke with the Editor of the PANCAP Newsletter about the new initiative.

“We wanted to create a learning space that allowed us to do training and sensitization sessions that people could access both live and delayed,” explained Xavier, “We are not always able to pull all the sites together for a face-to-face meeting for a number of reasons and so this is one part of how we would mitigate for that”.

The E-learning programme utilizes webinars, video conferencing, pre-recorded sessions and podcasts as a means of sharing new information or even refreshers. “We will then make that available (post-event) through a centralized online space for people to access in their own time,” explained Xavier, “as a post evaluation, we will tie it to a mandatory number of education hours per staff level that requires members of the team to go in and engage with the material posted there. That component is not quite ready just yet”.

JASL E-Learning is an initiative of the in-house Monitoring and Evaluation Department and was officially launched on Wednesday 6 February 2019. A logo was also created to support and brand the platform.

Xavier further highlighted that the first learning engagement involved JASL’s Medical Director, Dr Jennifer Tomlinson who led a session on “Index Testing”. “We invited our CSO partners, The Ashe Company and Children First Agency to join. This has now added a new layer for how we could also improve capacity across agencies,” explained Xavier, “We are super excited about this one!”

Leaving no one behind continues to be the goal of the Partnership and its stakeholders as the Region continues to focus on initiatives that ensure equal access to prevention, care, treatment, and support for vulnerable populations.

On Zero Discrimination Day, 1 March 2019, UNAIDS is highlighting the urgent need to take action against discriminatory laws.  UNAIDS Executive Director Michel Sidibé called on countries to review their laws and policies to protect those vulnerable to discrimination.  “Laws should protect, not harm,” stated Sidibé, “All countries must carefully review their laws and policies to ensure equality and protection for all people, no exceptions”.

The campaign will be highlighted with social media messages from partners and stakeholders from across the region under the theme “act to change laws that discriminate”.

To maintain the momentum of ending stigma and discrimination, the Caribbean Regional Network of People Living with HIV and AIDS (CRN+) will launch #UnitedPositively at the opening ceremony of the upcoming Seventh Meeting of the National AIDS Programme Managers and Key Partners, 11 March 2019.

The initiative aims to target policymakers and high-level decision makers with social media messages from People living with and affected by HIV.  Messages will illustrate how discrimination and the fear of stigma prevent vulnerable populations from accessing prevention, care, treatment, and support.

According to Jason Shepherd, Senior Programme Officer, CRN+ “Despite the gains made in relation to vulnerable populations’ access to services to achieve prevention, it is not uncommon to hear testimonials from persons within our networks who continue to not access prevention and treatment services for fear of discrimination. Hence, #UnitedPositively aims to motivate people living with or affected by HIV to advocate with policymakers to review discriminatory laws and policies that impact vulnerable populations’ access. We need to stand up as one Caribbean against stigma and discrimination”.

Origin of the National AIDS Programme Managers and Key Partners Meeting 

The Partnership is preparing for the Seventh Meeting of National AIDS Programme Managers and Key Partners scheduled for 11 to 13 March 2019. This meeting is the brainchild of Professor Peter Figueroa who served as Chair of the Priority Area Coordinating Committee and Vice Chair of the PANCAP Executive Board from 2009 to the end of 2013. Prof. Figueroa, like other partners, recognized that PANCAP was challenged to transfer regional public goods to the countries. He reflected on the experience and success of the Annual meeting of the Expanded Programme on Immunization Programme Managers and recommended that the HIV response could benefit tremendously from a similar annual meeting. With funding from the Global Fund, this meeting became a reality.

Evolution 

After six years, the meeting has evolved as a forum for reflecting on the Region’s progress and challenges, discussing and agreeing on strategies that countries can implement to better respond to the epidemic and sharing of global developments and innovations and country experiences in implementing innovative strategies to achieve the end of AIDS. It fosters dialogue and respect among NAP managers and civil society partners and has allowed NAP managers to better appreciate the contributions of civil society partners. It provides regional and development partners with the opportunity to learn from the countries and to better tailor their assistance to support country needs.

Knowledge Management Share Fair 

We have also added an extra day for knowledge sharing and capacity building among NAP managers and civil society partners with funding from the PEPFAR-USAID Johns Hopkins University funded PANCAP Knowledge for Health Project. A fifth day is now dedicated to NAP managers only to enable them to meet and identify their priorities and needs including technical support from partners.

Platform for reflection 

This year the Planning Committee has agreed to create space for individual countries to reflect on each session and to indicate which strategy or innovation they can commit to implement and to report on the following year. This would facilitate increased transfer of regional public goods by allowing countries the flexibility to implement innovative strategies and activities that take into consideration the available human and financial resources.

Increased interest 

We have also seen increased interest in this meeting, which has expanded its target audience to include chief medical officers and permanent secretaries. All development partners in the Region now actively participate in this meeting.

We look forward to welcoming all partners and sharing and learning from each other and to the outcomes and follow up actions.

Funding is guaranteed for this meeting under the new three-year PANCAP-CVC-COIN Global Fund grant, which will commence on 1 October 2019.

I wish to extend a special thank you to the Planning Committee for framing an agenda that responds to the needs of our National AIDS Programmes.