I have called this series of comments “DOING and LEARNING in Eswatini”. In these blog posts, I have shared some of my experiences with a focus on the LEARNING. I have not yet written about the DOING of the work in my GSK PULSE volunteer assignment.
My assignment role was as a Pre-Exposure Prophylaxis (PrEP) costing volunteer with the Clinton Health Access Initiative (CHAI) in Mbabane, Eswatini. The goal of the PrEP demonstration project is to provide information for the Eswatini Ministry of Health on making PrEP drugs available through government managed health facilities. PrEP is a proven method for the prevention of HIV infections for “at risk” clients. The high number of people (15-49 years) living with HIV means that many sexually active adults in Eswatini are at risk of contracting HIV and could potentially benefit from PrEP as an additional method to prevent infection.
The CHAI PrEP project (“Sihlomile”, We Arm Ourselves, see https://clinicaltrials.gov/ct2/show/study/NCT03254550 for a study overview) is one of three demonstration projects, which the Eswatini Ministry of Health has coordinated during 2017 and 2018 with CHAI and two other NGO implementation partners. The Sihlomile project is associated with six small to medium primary health care clinics in rural and semi-rural areas of Eswatini. The project collects the clinical data from clients during their PrEP initiation assessment process and during their continuing engagement at scheduled follow-up visits. Separate individual interviews allow the project to gather information from selected clients and health care workers on their experiences with PrEP. The project also samples the time required for health care workers to perform the activities required for the PrEP initiation and follow-up visits.
The sampled activity times plus the national salary scales are the basis for me to estimate the labor costs for the PrEP processes. Combining these labor costs with the tendered costs of the required diagnostic lab tests and the PrEP drugs, I can estimate the costs of the PrEP initiation and follow-up for a standard individual client. The estimates will allow the Ministry of Health to understand the relative size of the major cost components (health care worker labor, diagnostic tests, and the PrEP drugs).
As I end my GSK PULSE volunteer assignment, what have the PrEP demonstration projects accomplished? The projects provided the real-world data and experience needed to assess the organizational, social, and financial planning challenges of expanding the PrEP distribution beyond the 22 centers of the three demonstration projects. With that information, the Ministry of Health has now committed to doubling the number of PrEP distribution centers every year for the next three years.
Every year more of the people of Eswatini will be able to say, “Sihlomile, We Arm Ourselves”.